Chylothorax associated with lymphatic reflux in a thoracic duct tributary after lung cancer surgery

Ishida, Hironori; Nakazawa, Kimitaka; Yanagihara, Akitoshi; Umesaki, Tetsuya; Taguchi, Ryo; Yamada, Akiko; Nitanda, Hiroyuki; Sakaguchi, Hirozo

doi:10.1111/1759-7714.14062

Cited by 2 publications

(1 citation statement)

References 8 publications

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“…Incidence of chylothorax after pulmonary resection was reported to be 0.7-2.3% [13,14]. Conservative therapies [14] in case of the small amount of chyle may be effective, including chemical pleurodesis [15] and percutaneous catheter embolization of the thoracic duct [16]. About 10% of chylothorax after lobectomy without response to conservative therapies required reoperation for thoracic duct ligation [17], while the chylothorax occurring after pneumonectomy usually required reoperation [18].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor

Mei

Feng

Tao

et al. 2022

J Cardiothorac Surg

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Background In this study, we aimed to summarize the extremely important lesson and experience in the whole process of surgical treatments of lung tumors for the benefit of steps taken to prevent against unplanned reoperation. Methods Demographical and clinical information of 7732 patients were retrospectively retrieved and reviewed, who were diagnosed with pulmonary tumor and underwent surgical treatments from January 2016 to March 2021. Those patients who underwent unplanned reoperation for the treatment of severe complications were focused carefully and analyzed meticulously. Results A total of forty-one patients (41/7732) received 44 unplanned reoperations. Among them, eight and thirty-three patients were diagnosed with benign and malignant tumor, respectively. The incidence of unplanned reoperations seemed to be similar on both sides (Left vs. Right: 12/3231 vs. 29/4501, p = 0.103). Lobectomy plus segmentectomy is prone to reoperation (2/16, 12.5%) as compared to the other types of surgery. The complications leading to reoperation was hemothorax, including active hemorrhage (23/44, 52.3%) and clotted hemothorax (6/44, 13.6%), chylothorax (8/44, 18.2%), and the others (7/44, 15.9%) including bronchopleural fistula, torsion, or injury of right middle bronchus and pulmonary bulla rupture. The morbidity and mortality after unplanned reoperation were 17.1% (7/41) and 12.2% (5/41), respectively. Conclusions Bronchi or vessel stumps, the surgical edges of the lung parenchyma, and pleural adhesions should be checked to avoid postoperative bleeding. Prophylactic ligation of the thoracic duct should be recommended in case of the suspected oily-like exudation in the lymph node bed. Smooth expansion of the middle lobe is important to avoid narrowing and torsion before transection of the bronchus.

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Section: Discussionmentioning

confidence: 99%

Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor

Mei

Feng

Tao

et al. 2022

J Cardiothorac Surg

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Lymphangiography and lymphatic embolisation for the treatment of chyle leaks after neck surgery: assessment of lymphangiography findings and embolisation techniques

Kim

Bang

Choi

et al. 2023

The British Journal of Radiology

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Objective: To assess lymphangiography findings and outcome of lymphatic embolisation to manage chyle leak after neck surgery. Methods: Consecutive cases of lymphangiography performed between April 2018 and May 2022 for management of chyle leaks related to neck surgery were retrospectively reviewed. Lymphangiography findings, techniques, and outcomes were analysed. Results: Eight patients (mean age: 46.5 years) were included. Six patients had undergone radical neck dissection for thyroid cancer, and two had undergone lymph node excision. Clinical presentations were: chyle drainage through Jackson Pratt catheters in 5 patients, lymphorrhea through surgical wounds in two, and enlarging lymphocele in one. Lymphangiography techniques included: inguinal lymphangiography in 4 patients, retrograde lymphangiography in 3, and transcervical lymphangiography in one. Lymphangiography revealed leaks in the terminal thoracic duct in 2 patients, bronchomediastinal trunk in 2, jugular trunk in 3, and superficial neck channels in one. Embolisation techniques included: non-selective embolisation of terminal thoracic duct (n = 2), selective embolisation of the jugular trunk (n = 3), selective embolisation of the bronchomediastinal trunk (n = 2), and intranodal glue embolisation of superficial neck channels (n = 1). One patient underwent a repeat procedure. Chyle leak resolved in all patients over a mean of 4.6 days. No complication was encountered. Conclusions: Lymphatic embolisation seems to be effective and safe in managing chyle leaks after neck surgery. Lymphangiography allowed for the categorization of chyle leaks according to their location. Post-embolisation patency of the thoracic duct may be preserved in chyle leaks that do not directly involve the thoracic duct. Advances in knowledge: Lymphatic embolisation is safe and effective in managing chyle leaks after neck surgery. On lymphangiography, the location of contrast media extravasation may not be consistent. The technique for embolisation should be based on the location of the leak. Post-embolisation patency of the thoracic duct may be preserved in chyle leaks that do not directly involve the thoracic duct.

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Chylothorax associated with lymphatic reflux in a thoracic duct tributary after lung cancer surgery

Cited by 2 publications

References 8 publications

Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor

Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor

Lymphangiography and lymphatic embolisation for the treatment of chyle leaks after neck surgery: assessment of lymphangiography findings and embolisation techniques

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