The postoperative drain lymphocyte count as a novel predictor of chyle leakage after pancreatic surgery

Chyle leakage is a recognized complication of pancreatic surgery. However, the risk factors for this condition have not been fully elucidated. This study aimed to evaluate whether the postoperative drain lymphocyte count can serve as a predictor of chyle leakage after pancreatic surgery. A total of 132 patients who underwent pancreatic resection, including pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy, between November 2021 and March 2025 were retrospectively analyzed. Patient characteristics and perioperative factors, including drain lymphocyte count, were examined in relation to the occurrence of chyle leakage, which were defined according to the 2017 International Study Group of Pancreatic Surgery criteria. Chyle leakage occurred in 17 patients (12.9%), all of whom were classified as Grade B. A univariate analysis demonstrated significant associations between chyle leakage and PD procedure (p = 0.03), open surgery (p = 0.04), vascular resection (p < 0.01), D2 lymph node dissection (p < 0.01), and a drain lymphocyte count ≥ 308/µL on postoperative day 3 (p < 0.01). A multivariate analysis identified a drain lymphocyte count ≥ 308/µL on postoperative day 3 as an independent risk factor for chyle leakage (p < 0.01). The postoperative drain lymphocyte count is a reliable and independent predictor of chyle leakage following pancreatic surgery.