Radiological management of postoperative lymphorrhea

Sommer, CM; Pieper, Claus Christian; Offensperger, Florian; Pan, Feng; Killguss, Hansjörg; Köninger, Jörg; Loos, Martin; Hackert, Thilo; Wortmann, Markus; D., T.; Maleux, Geert; Richter, G. M.; Kauczor, Hans Ulrich; Kim, J.; Hur, Saebeom

doi:10.1007/s00423-021-02094-z

Cited by 14 publications

(37 citation statements)

References 93 publications

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“…So far, TL has been increasingly used to manage postoperative chylothorax with a technical success rate of 95–100% ( 5 , 6 , 8 , 9 , 23 ). Except for the embolization effect, ethiodized oil can induce sterile inflammation at the fistula, beneficial for subsequent histological repair ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

“…It can provide more explicitly anatomical details of the lymphatic system ( 20 , 28 , 29 ). If TL treatment fails, these CT data can also assist in planning further lymphatic interventional therapies, such as ALVS mentioned above and thoracic duct embolization ( 8 , 9 , 11 , 20 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…In the cases with high-dose postoperative chylothorax (>1,000 ml/d), conventional TL showed a poor efficiency rate of about 35%, so it was rarely solo performed ( 5 , 10 ). Instead, conventional TL with percutaneous lymphatic intervention (e.g., thoracic duct embolization or ALVS) was the optimal choice with a higher efficiency rate of 75–100% ( 9 ). However, by comparing the literature, the results of our study suggest that TL with high-dose ethiodized oil application probably has a better therapeutic effect.…”

Section: Discussionmentioning

confidence: 99%

“…The viscous ethiodized oil injected in TL can embolize the lymphatic leakage site ( 8 ). In literature, TL was reported with an overall treatment success rate of over 50% and a complication rate of <3% when treating postoperative chylothorax ( 5 , 7 , 9 ). Compared to surgical repair, TL is minimally invasive and can be tolerated by critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax

Liu

et al. 2021

Front. Med.

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Objective: To preliminarily explore the safety and effectiveness of transpedal lymphangiography (TL) with high-dose ethiodized oil application (>20 ml) in the treatment of high-output postoperative chylothorax.Methods: From 1 July 2020 to 1 July 2021, a total of 7 patients with high-flow postoperative chylothorax (> 1,000 ml/d) were retrospectively reviewed in a single center. Clinical data, including surgery types, technical and treatment success of TL, and adverse events of TL, were collected and analyzed.Results: Seven patients (5 cases of non-small cell lung cancer; 2 cases of esophageal carcinoma) with a median age of 62 years (range: 30–70 years) occurred postoperative chylothorax after tumor resection with mediastinal lymphadenectomy. All patients received conservative treatment including total parenteral nutrition and somatostatin administration for a median of 20 days (range: 15–31 days) that failed to cure the chylothorax, so TL was performed as a salvage. Before TL, the median daily chyle output was 1,500 ml/day (range: 1,100–2,000 ml/day). The technical success rate of TL was 100% (7/7), with the median volume of ethiodized oil of 27.6 ml (range: 21.2–30.0 ml) injected in TL. Ruptured thoracic duct was identified in 5 patients (5/7, 71%) in fluoroscopy and chest CT after TL. The treatment success rate of TL was 86% (6/7). In 6 patients, the thoracic drainage was removed after a median of 7 days (range: 4–13 days) from TL performance. No adverse event of TL was reported.Conclusion: Transpedal lymphangiography with high-dose ethiodized oil application (>20 ml) is a feasible, safe, and effective modality for the treatment of high-flow (> 1,000 ml/day) postoperative chylothorax.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax

Liu

et al. 2021

Front. Med.

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“…Lymphorrhea can occur after various types of surgeries, including esophagectomy, pneumonectomy, gastrectomy, pancreaticoduodenectomy, kidney transplantation, hysterectomy, prostatectomy, and lymph node resection [ 1 ]. Dehydration, nutritional deficiency, and immunological dysfunction may develop due to lymphorrhea [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Intranodal Lymphangiography during Surgical Repair of Pelvic Lymphorrhea after Radical Cystectomy

Onishi

Moribata

Shimizu

et al. 2021

Case Reports in Urology

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Lymphorrhea can develop after various types of surgeries. Surgical closure of the lymphatic leakage point is an effective treatment option. However, it is difficult to identify the leakage point sometimes. Here, we report a case of pelvic lymphorrhea after radical cystectomy for bladder cancer. Identification of the leakage point was difficult during laparoscopic surgical repair of lymphorrhea. Intranodal lymphangiography was performed via the inguinal lymph node by injection of lipiodol, followed by injection of indigo carmine. Laparoscopy revealed extravasation of lipiodol and indigo carmine from the pelvic wall. The leakage point was successfully cauterized using an electric scalpel. Lymphorrhea improved after the surgical repair. This case suggests that intranodal lymphangiography may be useful for detecting the site of lymphatic leakage during the surgical repair of lymphorrhea.

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Computed tomography-guided lymphangiography from the para-aortic lymph node: a useful approach for chylothorax after esophagectomy

Onikubo

Yagi

Yamada

et al. 2021

Gen Thorac Cardiovasc Surg

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Radiological management of postoperative lymphorrhea

Cited by 14 publications

References 93 publications

Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax

Preliminary Exploration of Transpedal Lymphangiography With High-Dose Ethiodized Oil Application in the Treatment of Postoperative Chylothorax

Intranodal Lymphangiography during Surgical Repair of Pelvic Lymphorrhea after Radical Cystectomy

Computed tomography-guided lymphangiography from the para-aortic lymph node: a useful approach for chylothorax after esophagectomy

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