Chylothorax after esophagectomy for esophageal cancer: Risk factors and management

Gupta, Rahul; Singh, Harjeet; Kalia, Saurabh; Gupta, Rajesh; Singh, Rajinder; Verma, Geetika

doi:10.1007/s12664-015-0571-6

Cited by 19 publications

(18 citation statements)

References 19 publications

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“…found that patients with chylothorax had tumors in the middle third of the thoracic esophagus, and the usual site of injury to the thoracic duct was in the mid-thorax during mediastinal dissection (13). A similar finding was reported by Rao et al who found that the incidence of chylothorax in middle-third lesions was relatively higher than that in lower-third lesions (14).…”

Section: Discussionsupporting

confidence: 65%

Localization of thoracic duct using heavily T2W MRI for intractable post-esophagectomy chylothorax—a case report

et al. 2017

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Post-esophagectomy chylothorax is a rare yet serious complication. Herein we report the case of a patient with intractable post-esophagectomy chylothorax despite medical treatment with total parenteral nutrition and octreotide, as well as prophylactic and repeated thoracic duct mass ligation. The patient was eventually treated with localization of thoracic duct using T2-weighted magnetic resonance imaging (T2W MRI), followed by video-assisted thoracoscopic thoracic duct ligation.

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Section: Discussionsupporting

confidence: 65%

Localization of thoracic duct using heavily T2W MRI for intractable post-esophagectomy chylothorax—a case report

et al. 2017

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“…Shah et al [ 18 ] found that it was associated with squamous cell carcinoma. Other risk factors include tumors located in the middle third of the esophagus [ 5 , 19 ] and positive lymph nodes [ 20 ]. Cervical anastomosis and neoadjuvant treatments were also considered as RFs [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Gupta et al [ 5 ] found that patients with complete response to neoadjuvant treatment had reduced CHT, while middle third tumors had less. In our patients, the response to preoperative therapy was not statistically significant (p=0.42), while lower esophageal tumors had a better correlation (p=0.107).…”

Section: Discussionmentioning

confidence: 99%

“…Its incidence after esophageal operations varies between 0.9% and 11.6% in the literature [ 1 - 3 ]. Different studies have discussed and researched the risk factors for developing CHT after esophageal and cardiopulmonary interventions including factors related to the patient, their treatment regimen, and the tumor [ 4 - 5 ]. Esophageal surgery remains technically challenging and requires a certain set of skills and experience.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the Surgeon’s Experience as a Risk Factor for Post-Esophagectomy Chylothorax on a Four-Year Cohort

Malibary¹,

Manfredelli

Almuttawa³

et al. 2020

Cureus

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Background: Chylothorax (CHT) is a known post-operative complication after esophageal surgery with vaguely defined risk factors. Methods: This is a retrospective chart review of 70 consecutive patients with operable cancer over a period of four years (January 2013 to December 2016). Ivor Lewis and McKeown interventions were performed. Thoracic duct is identified and ligated routinely. Factors related to the patient, the tumor, and the operating surgeon were analyzed. Results: Incidence of CHT was 10%. Surgeons with less than five years of esophageal surgery experience had the most CHT, 71% (p=0.001). No association was found between tumor location, type, body mass index (BMI), neoadjuvant therapy, response to neoadjuvant therapy or male sex, and CHT. The odds of developing CHT were 17 times higher in patients operated by a junior surgeon (odds ratio, OR=17.67, confidence interval, CI 2.68-116.34, p=0.003). Four patients (5.7%) had anastomotic leaks, none of them had CHT. Senior surgeons had less operative time and harvested more lymph nodes (p=0.0002 and p=0.1086 respectively). Conclusion: Surgeon’s experience might be considered a major risk factor to develop CHT. This finding needs to be confirmed by a larger multicentric series taking into consideration the human factor.

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“…The impact of neoadjuvant therapy for the treatment of esophageal cancer on postoperative chylothorax incidence is unknown and controversial. Gupta et al [16] evaluated 45 patients with esophageal cancer who underwent esophagectomy after neoadjuvant chemoradiotherapy and reported that difficult mediastinal dissection during esophagectomy in middle esophageal cancer may result in thoracic duct injuries, and a complete response to neoadjuvant chemoradiation may reduce the risk of chylothorax. Gronnier et al [17] outlined the results from a European multicenter study and suggested that neoadjuvant chemoradiotherapy increased chylothorax rates, with a trend toward more cardiovascular and thromboembolic events.…”

Section: Risk Factors For Chylothoraxmentioning

confidence: 99%

Chyle Leakage after Esophageal Cancer Surgery

Yang

Park

Kim

2020

Korean J Thorac Cardiovasc Surg

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Surgeons recommend dissecting lymph nodes in the thorax, abdomen, and neck during surgery for esophageal cancer because of the possibility of metastasis to the lymph nodes in those areas through the lymphatic plexus of the esophageal submucosal layer. Extensive lymph node dissection is essential for accurate staging and is thought to improve survival. However, it can result in several complications, including chyle leakage, which refers to continuous lymphatic fluid leakage and can occur in the thorax, abdomen, and neck. Malnutrition, fluid imbalance, and immune compromise may result from chyle leakage, which can be potentially life-threatening if it persists. Therefore, various treatment methods, including conservative treatment, pharmacological treatment such as octreotide infusion, and interventions such as thoracic duct embolization and surgical thoracic duct ligation, have been applied. In this article, the risk factors, diagnosis, and treatment methods of chyle leakage after esophagectomy are reviewed.

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Chylothorax after esophagectomy for esophageal cancer: Risk factors and management

Cited by 19 publications

References 19 publications

Localization of thoracic duct using heavily T2W MRI for intractable post-esophagectomy chylothorax—a case report

Localization of thoracic duct using heavily T2W MRI for intractable post-esophagectomy chylothorax—a case report

Evaluating the Surgeon’s Experience as a Risk Factor for Post-Esophagectomy Chylothorax on a Four-Year Cohort

Chyle Leakage after Esophageal Cancer Surgery

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