Chyle Leak Following Radical En Bloc Esophagectomy with Two-Field Nodal Dissection: Predisposing Factors, Management, an
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Chyle Leak Following Radical En Bloc Esophagectomy with TwoField Nodal Dissection: Predisposing Factors, Management, and Outcomes Pamela Milito, MD1,2, Jakub Chmelo, MUDr, MRCSEd1, Lorna Dunn, MD, FRCSEd1,3, Sivesh K. Kamarajah, BMedSci, MBChB1, Anantha Madhavan, MBChB, MRCSEd1, Shajahan Wahed, MD, FRCS1, Arul Immanuel, MD, FRCSEd1, S. Michael Griffin, OBE, MD, PRCSEd1, and Alexander W. Phillips, MD, MA, FRCSEd, FFSTEd1,4 Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK; 2University of Milan, Milan, Italy; 3Northumbria Healthcare NHS Foundation Trust, Northumbria, UK; 4School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
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ABSTRACT Background. Chyle leak is an uncommon complication following esophagectomy, accounting for significant morbidity and mortality; however, the optimal treatment for the chylothorax is still controversial. Objective. The aim of this study was to evaluate the incidence, management, and outcomes of chyle leaks within a specialist esophagogastric cancer center. Methods. Consecutive patients undergoing esophagectomy for esophageal cancers (adenocarcinoma or squamous cell carcinoma) between 1997 and 2017 at the Northern Oesophagogastric Unit were included from a contemporaneously maintained database. Primary outcome was overall survival, while secondary outcomes were overall complications, anastomotic leaks, and pulmonary complications. Results. During the study period, 992 patients underwent esophagectomy for esophageal cancers, and 5% (n = 50) of them developed chyle leaks. There was no significant difference in survival in patients who developed a chyle leak compared with those who did not (median: 40 vs. 45 months; p = 0.60). Patients developing chyle leaks had a significantly longer length of stay in critical care
Ó The Author(s) 2020 First Received: 3 May 2020 Accepted: 31 October 2020 A. W. Phillips, MD, MA, FRCSEd, FFSTEd e-mail: [email protected]
(median: 4 vs. 2 days; p = 0.002), but no difference in total length of hospital stay. Conclusion. Chyle leak remains a complication following esophagectomy, with limited understanding on its pathophysiology in postoperative recovery. However, these data indicate chyle leak does not have a long-term impact on patients and does not affect long-term survival.
Chyle leak after transthoracic esophagectomy has a reported incidence of 1–9%.1,2 This complication has been associated with a higher rate of morbidity and mortality among patients who underwent surgery, ranging between 0 and 50%.1,3,4 The reasons for this are explained by the continuous loss of chylous fluid, which is naturally rich in fats, fat-soluble vitamins, enzymes and lymphocytes, leading to a decrease in serum levels of albumin and a significant reduction in peripheral lymphocytes that can result in malnutrition and immunosuppression. Moreover, this fluid loss may lead to hypovolemia and subsequent respiratory failure.5,6 Postoperative chyle leaks result mainly from dama
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