71658 - Postoperative chyle leak – Less likely in obese patients and associated with postoperative mortality

Introduction

Esophagectomy can be complicated by postoperative chyle leak (PCL). PCL is rare and can be challenging to manage. Predisposing factors and the impact of PCL on survival are not fully understood.

This study aimed to investigate risk factors for PCL in a national cohort and its associations with outcomes and survival.

Method

All patients with esophageal cancer in the Swedish Registry for Esophageal and Gastric Cancer (NREV) who underwent esophagectomy between 2006 and 2018 with information on PCL were included in the study. Risk-factors and protective-factors of PCL were explored with multivariable logistic regression and 90-day mortality was described. Survival was studied with Cox-regression and the Kaplan-Meier method.

Result

The study included 1540 patients. 51 patients (3.3%) had PCL of which 32 (62.7%) were managed operatively. Median time-in-hospital increased with 14 days from 15 to 29 days in patients with PCL compared to patients without.

In multivariable logistic regression, overweight (BMI>25) and obese (BMI>30) patients were less likely to suffer from PCL, OR 0.41 (0.19-0.88 95%CI) and OR 0.28 (0.08-0.97) respectively.

In patients with PCL, 90-day mortality was increased three-fold, 15.7% vs 5.0%, and median survival was reduced by six months (28.8 vs 34.8 months) compared to patients without PCL.

PCL was not associated with adjusted long-term survival, HR 1.12 (0.75-1.66 95%CI).

Discussion

This study finds a reduced risk of PCL in obese esophageal cancer patients by unknown mechanisms that should be further explored. Although short-term mortality is clearly affected by PCL, the complication does not seem to impact long-term survival.