An effective method to reduce lymphatic drainage post-lateral cervical lymph node dissection of differentiated thyroid cancer: a retrospective analysis

Abstract

Background Lymph or chyle leak (LL/CL) is severe complications after lateral cervical lymph node dissection (LLND), mainly due to iatrogenic injury of the lymphatic duct. Efficient and well-operated methods to reduce postoperative drainage are still lacking. This was a feasibility study to evaluate a new method of preventing LL/CL compared to conventional treatment. Method We retrospectively analyzed 20 consecutive patients who used the “pedicled omohyoid flap covering (POFC)” method during LLND from January 2019 to December 2021 in our center as an observation group. Another 20 consecutive patients used the conventional method during LLND in this period as a control group. The clinical and pathological features of the two groups were compared, and the related factors that affected postoperative lymphatic drainage were analyzed with Cox proportional hazards models. Results The drainage volume per 24 h and the incidence of LL/CL in the control group were both higher than that in the observation group (all P < 0.05), and the number of lymph nodes dissected in the IV region > 10 and the use of the POFC method were the independent risk factors that significantly affected the incidence of LL/CL post LLND (all P < 0.05). Conclusions POFC is a safe and useful method for reducing drainage and preventing LL/CL post-LLND, especially for patients with heavy metastasis of the lymph nodes in the IV region.

Chyle leak after head and neck surgeries: a comprehensive review of diagnosis and management strategies

“…Similarly, the omohyoid muscle can be used by severing its hyoid attachment. Zhang et al 69 used an omohyoid-based flap to cover the level IV region and reinforced this flap with non-absorbable sutures to the surrounding soft tissues.…”

Usefulness of preoperative ice cream consumption and novel postoperative drainage management in patients undergoing left-sided neck dissection for thyroid cancer: a nonrandomized prospective study

“…Furthermore, several studies reported chylothorax following endoscopic lung or esophageal cancer resection using certain energy devices; therefore, such devices are not completely reliable [ 13 , 14 ]. Zhang et al [ 15 ] recently reported the usefulness of pedicled omohyoid flap coverings in preventing postoperative lymph node or chyle leakage. However, their study enrolled only a few patients, and the procedure was complicated.…”

“…However, their study enrolled only a few patients, and the procedure was complicated. Thus, the generalizability of the findings is questionable [ 15 ]. As mentioned above, no effective chyle prevention method has yet been established.…”