Strategic Approach to Massive Chylous Leakage after Neck Dissection

Abstract

(1) Background: A high volume of chylous leakage (>1 L/day) is a potentially lethal complication after neck dissection. However, a strategic treatment for when the leakage progresses from high to massive (>4 L/day) is lacking. (2) Methods: The PubMed database was searched for articles on neck dissection–associated chylous leakage. Nine articles that included 14 cases with >1 L/day chylous leakage (CL) were analyzed. (3) Results: Of the nine patients with 1–4 L/day CL, three were successfully managed with conservative treatment, two with thoracic ductal ligation, three with ductal embolization, and one with local repair with a strap muscle flap. Of the remaining five cases with >4 L/day chylous leakage, three were successfully treated with the pectoralis major myocutaneous flap (PMMF) and one was successfully treated with thoracic ductal ligation and one case died. (4) Conclusions: In this review, when leakage was >4 L/day, the aforementioned interventions were ineffective, but applying the PMMF could rescue the intractable complication. We propose a strategic treatment for high (1–4 L/day) and massive (>4 L/day) chylous leakage.

Chyle leak after head and neck surgeries: a comprehensive review of diagnosis and management strategies

“…The clavicular head of the SCM is separated from its site of origin, positioned on the wound bed, and secured to the surrounding soft tissues. In radical neck dissection, if the SCM has been sacrificed, the levator scapulae muscle can serve the same purpose 68 . Similarly, the omohyoid muscle can be used by severing its hyoid attachment.…”

“…Chang and colleagues have endorsed the use of a pectoralis major myocutaneous flap for intractable CL. The proximity of this bulky muscle to the lower neck makes it ideal for defect closure as it forms an effective barrier and seals off the leak 68 .…”

Massive Chylous Leakage After Endoscopic Thyroidectomy with Central Lymph Node Dissection: A Case Report

“…If local compression is ineffective, other conservative treatment options will be used. Surgical intervention is generally recommended in the following situations: (1) persistence of a high drainage volume (>1000 mL/day, or some recommend >500 mL/day for 3 consecutive days) with no significant reduction despite conservative management [6,8]; in particular, timely surgical intervention is warranted for the patient with a drainage volume exceeding 2000 mL/day [17]; (2) severe malnutrition and electrolyte imbalance [9]; and (3) other serious complications. The surgical indications above for CL are predominantly derived from cases following lateral neck dissection.…”

Case report: Balloon compression for cervical chyle leakage post neck dissection

“…The incidence varies according to the surgical extent, and it more commonly occurs when extranodal extension is involved around the level IV compartment (12). According to the results of a previous study, a CL volume of 1 L/day is often used as a cutoff value to classify CL volumes as low and high (6). High-volume CL is a clinically inevitable and severe problem that can cause hypovolemia, malnutrition, electrolyte disturbances, metabolic imbalance, immunosuppression, dehydration, poor wound healing and prolonged length of hospital stay (13).…”

“…Currently, there is no standardized treatment for the management of CL (3); usually, the first line of treatment is conservative management, such as a modified diet, drainage of effusion, pressure dressings, and the administration of octreotide and etilefrine (4), which are useful for most cases. However, high output fistulas (>1 L/day) or prolonged drainage with a low CL volume (a duration >7 to 14 days) will often respond unsatisfactorily to conservative management alone and require surgical intervention (5,6). Herein, we report a case of a patient with high-volume cervical CL of 1100 ml/day who was treated successfully by balloon compression, and the patient successfully avoided reoperation.…”