Esophagectomy with en bloc resection of the thoracic duct: Risk factors for post-operative chyle leak and current management

Brian Ip, Ka Ting NG, Simon Packer, Simon Paterson-Brown, Graeme W Couper

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background Routine ligation of the thoracic duct during oesophagectomy has been reported to reduce the rate of chyle leak following oesophagectomy. This study aims to identify risk factors for developing a chyle leak (CL) with this approach and review current management. Methods All patients who underwent transthoracic oesophagectomy over a 3-year period were identified from a prospectively collected database and their medical records reviewed. Results A total of 147 oesophagectomies were performed in the period January 2012-December 2014. 18 patients with anastomotic leak were excluded. Eleven (8.5%) of the remaining 129 patients developed a chyle leak. Statistically significant predictive factors for chyle leak were squamous cell carcinoma (6/16, 37.5% vs 5/113, 4.4% in other tumour types P=0.0005) and high total chest drain volumes on day 2 post operatively measured prior to commencing enteric feeding. Using a threshold of 600mls on day 2, the sensitivity and specificity for predicting chyle leak are 92% and 82% respectively. Low BMI (mean 24.1 with chyle leak vs 27.5 without chyle leak) was also associated with a CL, but was not statistically significant. Neither the extent of lymphadenectomy nor the extent of lymph node involvement (N stage) were associated with chyle leak. Six patients with a low volume chyle leak (<600mls/day) were successfully managed conservatively. The main thoracic duct was never the source of leakage in the 5 patients requiring re-thoractomy. All 11 patients were successfully discharged home. Conclusion This study demonstrates squamous cell carcinoma remains a significant risk factor for the development of post-oesophagectomy chylothorax despite the routine ligation of the thoracic duct. In the knowledge that with this approach the main thoracic duct is never the source of chyle leak, patients with a chest drainage of <600mls/24hrs can be successfully treated conservatively. Patients with a chest drain volume of >600mls/24hrs despite conservative management should undergo re-thoractomy at an early stage.
    Original languageEnglish
    Journalannals of esophagus
    DOIs
    Publication statusPublished - 11 Sept 2019

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