Postoperative chyle leak after pancreatic surgery: scoping review

Chyle leak is a significant complication after pancreatic resection, associated with increased morbidity and mortality. Data on its incidence, risk factors, and treatment are inconsistent. Robotic pancreatic resections are increasingly performed and assumed to be associated with fewer complications than open surgery. This study evaluated the incidence, risk factors, and therapeutic strategies for chyle leak after both open and robotic pancreatic surgery.

A scoping literature review was conducted across multiple databases to identify studies that included patients who underwent open or robotic pancreatic resection and experienced chyle leak as defined by the International Study Group on Pancreatic Surgery. The search period extended from database inception until 27 August 2025.

In all, 58 studies published between 2007 and 2025 (30 039 patients) were included in the analysis. The pooled incidence of chyle leak after pancreatic resection was 8.0%. Procedure-specific pooled incidences of chyle leak were 9.5% after partial pancreatoduodenectomy, 8.4% after pylorus-preserving pancreatoduodenectomy, 6.9% after distal pancreatectomy, 1.7% after enucleation, and 6.2% after total pancreatectomy. In seven comparative studies (6339 patients), the pooled incidence of chyle leak was 10% after robotic pancreatoduodenectomy and 12% after open pancreatoduodenectomy.

Chyle leak is an important complication following pancreatic resection. Despite advances in surgical techniques, the risk remains substantial, with no clinically significant difference in the rate of chyle leak between robotic and open pancreatoduodenectomy resections.