Download PDF
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
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

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

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Bryant AS, Minnich DJ, Wei B, Cerfolio RJ. The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg 2014; 98 (01) 232-235 , discussion 235–237
    CrossrefPubMedGoogle Scholar
  • 2 Takuwa T, Yoshida J, Ono S. , et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg 2013; 146 (03) 571-574
    CrossrefPubMedGoogle Scholar
  • 3 Martucci N, Tracey M, Rocco G. Postoperative chylothorax. Thorac Surg Clin 2015; 25 (04) 523-528
    CrossrefPubMedGoogle Scholar
  • 4 Markham KM, Glover JL, Welsh RJ, Lucas RJ, Bendick PJ. Octreotide in the treatment of thoracic duct injuries. Am Surg 2000; 66 (12) 1165-1167
    PubMedGoogle Scholar
  • 5 Reisenauer JS, Puig CA, Reisenauer CJ. , et al. Treatment of postsurgical chylothorax. Ann Thorac Surg 2018; 105 (01) 254-262
    CrossrefPubMedGoogle Scholar
  • 6 Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative chylothorax. J Thorac Cardiovasc Surg 1996; 112 (05) 1361-1365 , discussion 1365–1366
    CrossrefPubMedGoogle Scholar
  • 7 Cho HJ, Kim DK, Lee GD. , et al. Chylothorax complicating pulmonary resection for lung cancer: effective management and pleurodesis. Ann Thorac Surg 2014; 97 (02) 408-413
    CrossrefPubMedGoogle Scholar
  • 8 Bessone LN, Ferguson TB, Burford TH. Chylothorax. Ann Thorac Surg 1971; 12 (05) 527-550
    CrossrefPubMedGoogle Scholar
  • 9 Patterson GA, Todd TR, Delarue NC, Ilves R, Pearson FG, Cooper JD. Supradiaphragmatic ligation of the thoracic duct in intractable chylous fistula. Ann Thorac Surg 1981; 32 (01) 44-49
    CrossrefPubMedGoogle Scholar
  • 10 Selle JG, Snyder III WH, Schreiber JT. Chylothorax: indications for surgery. Ann Surg 1973; 177 (02) 245-249
    CrossrefPubMedGoogle Scholar
  • 11 Murphy TO, Piper CA. Surgical management of chylothorax. Am Surg 1977; 43 (11) 715-718
    PubMedGoogle Scholar
  • 12 Marthaller KJ, Johnson SP, Pride RM, Ratzer ER, Hollis Jr HW. Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration. Am J Surg 2015; 209 (02) 235-239
    CrossrefPubMedGoogle Scholar
  • 13 Vallieres E, Shamji FM, Todd TR. Postpneumonectomy chylothorax. Ann Thorac Surg 1993; 55 (04) 1006-1008
    CrossrefPubMedGoogle Scholar