Chyle Leak Following Pancreatic Resection: A Potential Contributor to Delayed Postoperative Recovery

Chyle leaks following pancreatic resection are often considered less clinically significant than postoperative pancreatic fistulas (POPFs), despite their potential to delay recovery. We evaluated postoperative outcomes associated with chyle leak and explored differences in morbidity relative to POPF. A retrospective review of consecutive pancreatic resections performed at a single institution between 2017 and 2022 was conducted. Among 369 patients, 24 (6.5%) developed chyle leaks, including 16 (4.3%) isolated chyle leaks and 8 (2.2%) combined chyle and pancreatic leaks. Isolated chyle leaks were diagnosed at a median of postoperative day 7. Compared with 165 patients with isolated POPF, patients with isolated chyle leaks had larger pancreatic duct diameters (P = 0.001), higher rates of neoadjuvant chemotherapy (P = 0.039), and greater lymph node harvests (P = 0.002). Patients without leaks had shorter hospital stays and earlier drain removal. No statistically significant differences were detected between isolated chyle leak and POPF in hospitalization, drain duration, nutritional support, readmission, percutaneous drainage, reoperation, or mortality; however, the small chyle-leak cohort precludes conclusions of equivalence. Patients with combined leaks (n = 8) had high resource utilization, including 75% readmission and parenteral nutrition rates, but this subgroup was too small for definitive comparative inference. These findings suggest that clinically apparent chyle leak may contribute meaningfully to delayed recovery and support further study in larger, prospectively, and systematically assessed cohorts.