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Thorac Cardiovasc Surg 2020; 68(06): 520-524
DOI: 10.1055/s-0040-1710071
Original Thoracic

Treatment of Chylothorax after Lung Resection: Indications, Timing, and Outcomes

Francesco Petrella 
1   Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Lombardia, Italy
2   Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
,
Monica Casiraghi 
1   Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Lombardia, Italy
,
Davide Radice
3   Division of Epidemiology and Biostatistics, IRCCS European Institute of Oncology, Milan, Lombardia, Italy
,
Luca Bertolaccini
1   Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Lombardia, Italy
,
Lorenzo Spaggiari
1   Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Lombardia, Italy
2   Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Abstract

Background Chylothorax following pulmonary resection and lymphadenectomy for cancer is a potential severe complication in thoracic surgery. In the present study, we investigated the efficacy of the nonsurgical approach as well as the need for reoperation after conservative approach failure.

Methods Chylothorax was diagnosed when chylous leakage from the chest drainage was observed and confirmed by the presence of triglycerides in the pleural fluid. We initially treated all the patients conservatively with complete oral intake cessation and total parenteral nutrition; if drainage output remained more than 800 mL/d after the first 5 days or major pleural effusion was observed at chest X-ray after chest tube removal, surgical treatment of chylothorax was indicated.

Results Between January 1998 and December 2018, 5,072 patients underwent standard anatomical resection and mediastinal lymph node dissection for cancer at our institution. Among them, 30 patients (0.6%) developed chylothorax: 20 patients were effectively treated only by nil per os and low-fat diet, while 10 patients (33.3%) required surgical treatment. Mean age was 63 years; there were 24 male patients (80%); right-sided chylothorax was more frequent than left-sided chylothorax (22 vs. 8, respectively) although not statistically significant (p = 0.38); the only factor that seems to influence the need for reoperation is chylothorax flow rate during conservative treatment (p = 0.06).

Conclusion Conservative treatment is effective in the case of low flow-rate chylothorax (< 800 mL/d); in the case of a higher flow rate, surgical exploration is needed and thoracic duct ligation—with or without lymphatic sites clipping—provides definitive lymphostasis.

Keywords

chylothorax - thoracic duct ligation - lung resection

Disclosure

The authors have no conflicts of interest to declare. No funding was used to support this work.




Publication History

Received: 05 November 2019

Accepted: 09 March 2020

Article published online:
03 June 2020

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