Chyle fistula in right cervical area after thyroid surgery

Jiménez, Pablo Priego; Guirao, María Vicenta Collado; Blanco, Roberto Rojo; Marino, Raquel Grajal; Velasco, Gloria; Villanueva, Augusto

doi:10.1007/s12094-008-0257-4

Cited by 18 publications

(20 citation statements)

References 12 publications

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“…Priority must be given to the prevention of lymph fistulas related to an injury of the main thoracic duct or one of its multiple branches (40% of cases) [3, 6, 8, 10]. A meticulous surgical technique combined with magnifying glasses has recently been advocated by Lorenz et al [6].…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative diagnosis of lymphatic leakage is better treated immediately by ligature (3-0 or 4-0 non-absorbable) than suture procedures [6, 9]. In most cases, postoperative diagnosis is clinically obvious and no complementary investigations such as lymphoscintigraphy and/or CT scan are required [3, 8]. Chyle fistula usually starts after an oral diet, with an increase of drainage volume with milky appearance, swelling of supraclavicular fossa, erythema or induration of the skin [3, 6, 8].…”

Section: Discussionmentioning

confidence: 99%

“…First described by Cushing in 1898, chyle fistula can induce severe nutritional, metabolic and immune disturbances, delay wound healing, prolong hospital stay and, in the past, even resulted in death [1, 2]. The incidence rate reported in the literature ranges from 0.5 to 2.5% [1, 2, 3, 4, 5, 6, 7, 8]. In thyroid surgery, the rate of chyle fistula increases significantly (p < 0.001) with the extent of the surgical procedure: 0.5% after less than total surgery with central compartment node dissection (CCND), 0.8% in patients with total thyroidectomy and CCND, 5.1% after total thyroidectomy associated with ipsilateral neck dissection, and 6.2% in patients treated by total thyroidectomy with bilateral neck dissection [5].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment

Rodier¹,

Volkmar²,

Bodin³

et al. 2011

Case Rep Oncol

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The use of somatostatin analogs is a new conservative therapeutic approach for the treatment of chyle fistulas developing after thyroid cancer surgery. The combination therapy with a total parenteral nutrition should avoid the high morbidity of are-intervention with an uncertain outcome. This promising trend is supported by the present case report of a chyle leak occurring after total thyroidectomy with central and lateral neck dissection for a papillary carcinoma, which was treated successfully without immediate or distant sequelae.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment

Rodier¹,

Volkmar²,

Bodin³

et al. 2011

Case Rep Oncol

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“…Para essa Medida #1 estabeleceu-se um cut-off de 19mm como teste diagnóstico para prever a desembocadura do DT na CJS, com sensibilidade de 86.7% (CI95%:59. 5 ABSTRACT: BACKGROUND: During a neck dissection involving the left IV level, the final segment of the thoracic duct (TD) may be injured, significantly increasing postoperative morbi-mortality. The best treatment is its prevention.…”

Section: Resumo: Introduçãomentioning

confidence: 99%

“…During a neck dissection involving level IV on the left side, there is a risk of injury of this important lymphatic vessel at its final segment, before entering the venous system. Albeit infrequent, being reported in 1-3% of the cases [3][4][5][6][7][8][9][10][11][12][13] , this complication may bring significant postoperative morbidity causing a prolonged time of hospitalization. This represents higher therapy-related costs and even higher risks for the patient's health.…”

Section: Introductionmentioning

confidence: 99%

Biometric measurements involving the terminal portion of the thoracic duct on left level IV: an anatomic study

Louzada

Lim

Yoshio

et al. 2015

Rev. Med. (São Paulo)

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. Medidas biométricas envolvendo a porção terminal do ducto torácico no nível cervical IV à esquerda: um estudo anatômico / Biometric measurements involving the terminal portion of the thoracic duct on left level IV: an anatomic study. Rev Med (São Paulo). 2015 jan.-mar.;94(1):1-5. RESUMO: INTRODUÇÃO:No esvaziamento cervical do nível IV à esquerda, a porção final do ducto torácico (DT) pode ser lesada, aumentando significativamente a morbimortalidade pós-operatória. O melhor tratamento é a prevenção. Contudo, não há disponível na literatura medidas biométricas que auxiliem a identificação da desembocadura do DT. MATERIAIS E MÉTODOS: a desembocadura do DT foi identificada e distâncias úteis foram medidas em 25 cadáveres não-formolizados. Análise estatística foi realizada para verificar associações. RESULTADOS: a desembocadura do DT ocorreu na confluência jugulo-subclávia (CJS -60%), na veia jugular interna esquerda (VJIE -36%) e na veia braquiocefálica esquerda (4%). Uma associação estatisticamente significante foi encontrada entre a desembocadura na confluência jugulo-subclávia e a distância entre a VJIE e o músculo omo-hioide (Medida #1). Indivíduos cujo DT desemboca na CJS apresentaram a Medida #1 com mediana de 34.5±12.0mm, já os com desembocadura na VJIE apresentaram mediana de 22.3±8.7mm (p=0.015 -Student´s t-test). A regressão logística demonstrou que para cada aumento de 10mm na Medida #1 há uma chance de 1.12x de encontrar a desembocadura do DT na CJS (OR=1.12; CI95%:1,01-1,25; p=0.032). Para essa Medida #1 estabeleceu-se um cut-off de 19mm como teste diagnóstico para prever a desembocadura do DT na CJS, com sensibilidade de 86.7% (CI95%:59.5-98.3%), especificidade de 55.6% (CI95%:21.2-86.3%), PPV de 76.5% (CI95%:50.1-93.2%), NPV de 71.4% (CI95%:25.8-97.2%) e ROC AUC de 79.3% (CI95%: 58.0-92.9%). CONCLUSÃO: este estudo anatômico demonstrou que o local de desembocadura do DT mais frequente é a CJS e que a Medida #1 é capaz de prever o local de desembocadura do DT. ABSTRACT: BACKGROUND: During a neck dissection involving the left IV level, the final segment of the thoracic duct (TD) may be injured, significantly increasing postoperative morbi-mortality. The best treatment is its prevention. However, there is a lack of helpful biometric measurements focusing on the TD termination in the literature. MATERIALS AND METHODS: The TD termination was identified and some helpful biometric measurements were obtained on 25 non-preserved cadavers. DESCRITORES:Statistical analysis was performed to analyze correlations. RESULTS: TD termination was found on the jugulo-subclavian junction (JSJ -60%), on the left internal jugular vein (LIJV -36%), and on the left brachiocephalic vein in 4%. A statistically significant association was found between TD termination on the JSJ and the distance between LIJV and omohyoid muscle (Measurement #1). Individuals with TD termination on the JSJ had median Measurement #1 of 34.5±12.0mm, compared with median Measurement #1 of 22.3±8.7mm among individuals with TD termination on LIJV (p=0....

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Management of lymph fistulas in thyroid surgery

Lorenz

Abuazab

Sekulla

et al. 2010

Langenbecks Arch Surg

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Data of this series support definition of the two categories of high- and low-output fistulas according to drainage collection with >300 versus <200 ml/day. Fasting in low-output fistula facilitates conservative treatment with closed drainage, whereas in high-output fistulas surgical intervention should be sought. Attendant criteria for treatment stratification are equally important, like patient's compliance, nutritional, and general health status as well as evidence for wound infection. Surgical closure of lymph fistula may be demanding when identification of the secreting fistula is limited and even muscle flap fortification may fail. Ultimately, in unsuccessfully reoperated fistula recurrences, open drainage may become necessary. Lymph fistulas cause significantly prolonged hospital stay, possible critical clinical decay, and unfavorable cosmetic and oncologic outcome while the superior management remains to be defined.

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Chyle fistula in right cervical area after thyroid surgery

Cited by 18 publications

References 12 publications

Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment

Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment

Biometric measurements involving the terminal portion of the thoracic duct on left level IV: an anatomic study

Management of lymph fistulas in thyroid surgery

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