Postesophagectomy Chylothorax: Incidence, Risk Factors, and Outcomes

Abstract

Background Chylothorax is a rare but potentially lethal complication of esophagectomy. The study aims were to evaluate the rate of postesophagectomy chylothorax, identify associated risk factors and compare postoperative outcomes with patients who do not develop chylothorax. Methods We reviewed 892 consecutive patients undergoing esophagectomy (1997-2008). Preoperative, operative and postoperative details, including adverse outcomes and mortality, were analyzed. Results We identified postesophagectomy chylothorax in 34 patients (3.8%). Chylothorax was significantly associated with adverse outcomes, including 30-day major complications (85% vs. 46%; p<0.001) and mortality (17.7 vs. 3.9%, p<0.001). Patients with chylothorax were significantly more likely to develop sepsis (p=0.001), pneumonia (p=0.009), need reintubation (p=0.002) or require reoperation (p<0.001). Median length of stay was significantly longer (17 vs. 8 days; p=0.005). Median time to chylothorax diagnosis was 5 days. Thoracic duct ligation was performed in 62% (n=21; median 13 days after esophagectomy). Repeat duct ligation for persistent chylothorax was required in 2 patients. Squamous cell cancer histology (9/34; 26%) was an independent predictor of postoperative chylothorax (OR 4.18; 95% CI 1.39, 12.6). Odds of chylothorax were 36 times greater with average daily chest tube output >400 ml in the first 6 postoperative days (OR 35.9; 95% CI 8.2, 157.8). Conclusions Postoperative chylothorax is associated with significant postoperative morbidity and mortality. Patients with squamous cell cancer may be at increased risk. In addition, >400 ml average daily chest tube output in the early postoperative period should prompt fluid analysis for chylothorax to facilitate early diagnosis and consideration of thoracic duct ligation.

Chylothorax after esophagectomy for esophageal cancer: Risk factors and management

“…Due to this low incidence, there is very few evidence on its predisposing factors and its optimal treatment of choice. Occurrence of chylothorax in postoperative period is associated with increase in the incidence of major complications and in hospital mortality by several folds [4]. Also, since the introduction of neoadjuvant therapy in the multimodality treatment of esophageal cancer, its impact on incidence of postoperative chylothorax is not known.…”

Chyle Leak After Esophageal Surgery

“…Shah and colleagues reported significant failure of conservative management if patients continued to have chest tube output over 11 cc/kg/d after beginning the treatment [44]. Dugue and colleagues used an output of chyle based upon body-weight ratio as an indicator of conservative treatment success and suggested that an output of less than 10 cc/ kg/d at day 5 of conservative treatment is justification to continue conservative management [24].…”

Early Postoperative Complications of Thoracic Esophageal Diverticula: A Review of 10 Cases from "Saint Mary" Hospital, Bucharest, Romania

“…Chylotorax is a rare complication after thoracic surgery, occurring in 0.5% to 2% after esophagectomy (35,36) and 1.4% to 2.3% after lung resection (37,38). Even rare, chylothorax can be a difficult complication leading to immunologic compromise, pneumonias and death in up to 30% of patients (39)(40)(41)(42).…”