Chylous Leakage After Retroperitoneal Minimally Invasive Surgery: A Multi-institutional Analysis of Risk Factors, Treatment Course, and Surgical Intervention.

Abstract

Objectives: To clarify the management approach for chylous leakage after retroperitoneal minimally invasive surgeries by investigating risk factors and clinical course with a video of the case requiring surgical intervention.

Methods: This retrospective study included 1258 patients who underwent minimally invasive retroperitoneal surgeries at four Japanese institutions between 2010 and 2023. We analyzed the risk factors for the onset of postoperative chylous leakage and reviewed the clinical courses in patients with chylous leakage, with a detailed evaluation of cases requiring surgical intervention.

Results: Chylous leakage occurred exclusively on the left in 2.1% (27/1258) of cases. It was associated with lymph node dissection (n = 22) or excessive hilar dissection around the left renal pedicle (n = 5). Multivariate analysis identified left-sided surgery and lymph node dissection as significant risk factors. Conservative management, including dietary therapy with or without octreotide, was effective in 25 cases (94%). However, two cases (6%) required surgical repair for persistent chylous leakage. In both cases, preoperative ingestion of fatty substances facilitated accurate intraoperative identification of the leakage site, allowing successful laparoscopic closure.

Conclusion: Chylous leakage is a notable postoperative complication of para-aortic lymph node dissection and extensive left hilar dissection during minimally invasive retroperitoneal surgeries. Although conservative management is effective in most cases, laparoscopic repair with preoperative fatty substance administration is a viable option for refractory cases.