Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment

Abstract

The use of somatostatin analogs is a new conservative therapeutic approach for the treatment of chyle fistulas developing after thyroid cancer surgery. The combination therapy with a total parenteral nutrition should avoid the high morbidity of are-intervention with an uncertain outcome. This promising trend is supported by the present case report of a chyle leak occurring after total thyroidectomy with central and lateral neck dissection for a papillary carcinoma, which was treated successfully without immediate or distant sequelae.

Use of Octreotide for the Management of Chyle Fistula Following Neck Dissection

“…6,7 Fewer studies have looked at chyle leaks in the neck following surgical dissection, with evidence of octreotide treatment success in these instances limited to case reports. 8,9 Octreotide therapy has been shown to be successful in high-volume leaks, with reported success in a 2300-mL chyle leak that persisted after 8 days of MCT diet then resolved 6 days after initiation of octreotide therapy with no adverse events. 8 We aimed to present our findings with the use of octreotide as a safe and effective means for prompt resolution of chyle leaks of the neck.…”

Single port thoracoscopic treatment of thoracic duct injury after thyroidectomy with neck dissection

“…In current literature nutritional, surgical and pharmacological procedures have been proposed for treatment (8). In addition, there is still a doubt for choice of surgical or conservative treatment (1,8,9).…”

“…Cervical thoracic duct injuries are rare but are well-known complications with an incidence about 0.5-6.2% (1,2). Due to left side prominent termination of thoracic duct, these injuries occur predominantly on the left side of patients underwent to lateral neck dissection (1).…”

“…Due to left side prominent termination of thoracic duct, these injuries occur predominantly on the left side of patients underwent to lateral neck dissection (1). Chylous fistulas occur between the first and third postoperative day in 86% of patients (1,3).…”

“…In the literature, these injuries can be managed either conservatively or surgically (1,4,5). Initial management of chylous fistula begins with dietary modifications such as diets poor in fat with medium chain triglycerides or total parenteral nutrition, repeated drainage, pressured dressings (2,4).…”