PS02.145: Treatment for Chylothorax After Thoracic Esophagectomy

Abstract

Background Chylothorax is relatively rare complication in esophagus cancer surgery. But once it happens, appropriate treatment is absolutely essential to avoid another severe complication. We report our treatment results of chylothorax after thoracoscopic esophagectomy and represent the appropriate treatment strategy for this complication. Methods We examined 468 patients who underwent thoracoscopic esophagectomy for esophageal cancer from January 2009 to November 2017. Thoracic duct was mostly preserved except the case which had cancer invasion. Also, MRI scan was performed in all cases to detect the location of thoracic duct preoperatively. When the surgical approach was planned for chylothorax after esophagectomy, 250ml of 20% soybean oil was administrated through jejunostomy tube 30 minutes prior to the surgery. Thoracic duct is usually detected at the inferior mediastinum by thoracoscopy and applies ligation or clipping. Treatment effect can be checked during the surgery by interruption of soybean oil leakage which was easily recognized before ligation. Results Postoperative chylothorax was detected in seven out of 468 cases (1.50%). Thoracic duct had been preserved in all of those seven cases. Among them, two cases improved just by drainage and five needed to undergo thoracoscopic thoracic duct ligature. The mean amount of daily thoracic drainage was 1106 ml in the ligation group whereas 565 ml in the conservative treatment group. The median hospitalization days after surgery among ligation and conservative group was 33.5 and 25days, the median day until oral intake was 21 and 13 days, the median days until thoracic drain removal was 10.5 and 9 days, respectively. Conclusion In the case of chylothorax after esophagectomy, early oral intake and short hospitalization was possible by performing thoracoscopic thoracic duct ligature, especially in the case which had large amount of pleural effusion drainage. MRI was useful equipment to detect the variant of thoracic duct and to perform thoracoscopic thoracic duct ligature safely. Disclosure All authors have declared no conflicts of interest.