Treatment of Postsurgical Chylothorax

Janani S. Reisenauer, Carlos A. Puig, Chris J. Reisenauer, Mark S. Allen, Emily Bendel, Stephen D. Cassivi, Francis C. Nichols, Rob K. Shen, Dennis A Wigle, Shanda H. Blackmon

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Postoperative chylothorax can be managed by any or all of observation, parenteral nutrition, surgical duct ligation, pleurodesis, or thoracic duct embolization. The objective of this study was to determine the efficacy of standard therapies, such as surgical duct ligation and observation, compared with newer treatment methods (thoracic duct embolization). Methods: A prospectively maintained database at a single institution was used to identify and review patients with postoperative chylothorax from 2008 to 2015. Results: Postoperative chylothorax occurred in 97 patients, including 54 men (56%). The median age was 61 years (range, 24 to 87 years). Thoracic duct leak followed esophagectomy in 46 patients (47%), pulmonary resection in 30 (31%), mediastinal mass resection in 7 (8%), and after other procedures in 15. Of 28 medically observed patients achieving resolution without intervention, the median peak chest tube output in 24 hours was 725 mL compared with 1,910 mL in the group that required intervention (p = 0.0001). Thoracic duct ligation was successful in 44 of 52 patients that proceeded to the operating room (85%). Of the 40 patients undergoing diagnostic lymphangiography, a leak was identified in 34 (85%), but the cisterna chyli could only be cannulated in 19 (48%) and was subsequently successful in 15 (38%). Conclusions: Patients with chylous chest tube outputs of 1,100 mL or more in 24 hours postoperatively should be considered for intervention. Intention-to-treat analysis shows surgical duct ligation is more effective than thoracic duct embolization, with the ability to cannulate the cisterna chyli being the limiting factor. Lymphangiography may help determine which patients are better treated with ligation or embolization.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Chylothorax
Thoracic Duct
Ligation
Lymphography
Chest Tubes
Therapeutics
Observation
Pleurodesis
Intention to Treat Analysis
Esophagectomy
Parenteral Nutrition
Operating Rooms
Databases
Lung

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Reisenauer, J. S., Puig, C. A., Reisenauer, C. J., Allen, M. S., Bendel, E., Cassivi, S. D., ... Blackmon, S. H. (Accepted/In press). Treatment of Postsurgical Chylothorax. Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2017.07.021

Treatment of Postsurgical Chylothorax. / Reisenauer, Janani S.; Puig, Carlos A.; Reisenauer, Chris J.; Allen, Mark S.; Bendel, Emily; Cassivi, Stephen D.; Nichols, Francis C.; Shen, Rob K.; Wigle, Dennis A; Blackmon, Shanda H.

In: Annals of Thoracic Surgery, 01.01.2017.

Research output: Contribution to journalArticle

Reisenauer, JS, Puig, CA, Reisenauer, CJ, Allen, MS, Bendel, E, Cassivi, SD, Nichols, FC, Shen, RK, Wigle, DA & Blackmon, SH 2017, 'Treatment of Postsurgical Chylothorax', Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2017.07.021
Reisenauer JS, Puig CA, Reisenauer CJ, Allen MS, Bendel E, Cassivi SD et al. Treatment of Postsurgical Chylothorax. Annals of Thoracic Surgery. 2017 Jan 1. https://doi.org/10.1016/j.athoracsur.2017.07.021
Reisenauer, Janani S. ; Puig, Carlos A. ; Reisenauer, Chris J. ; Allen, Mark S. ; Bendel, Emily ; Cassivi, Stephen D. ; Nichols, Francis C. ; Shen, Rob K. ; Wigle, Dennis A ; Blackmon, Shanda H. / Treatment of Postsurgical Chylothorax. In: Annals of Thoracic Surgery. 2017.
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abstract = "Background: Postoperative chylothorax can be managed by any or all of observation, parenteral nutrition, surgical duct ligation, pleurodesis, or thoracic duct embolization. The objective of this study was to determine the efficacy of standard therapies, such as surgical duct ligation and observation, compared with newer treatment methods (thoracic duct embolization). Methods: A prospectively maintained database at a single institution was used to identify and review patients with postoperative chylothorax from 2008 to 2015. Results: Postoperative chylothorax occurred in 97 patients, including 54 men (56{\%}). The median age was 61 years (range, 24 to 87 years). Thoracic duct leak followed esophagectomy in 46 patients (47{\%}), pulmonary resection in 30 (31{\%}), mediastinal mass resection in 7 (8{\%}), and after other procedures in 15. Of 28 medically observed patients achieving resolution without intervention, the median peak chest tube output in 24 hours was 725 mL compared with 1,910 mL in the group that required intervention (p = 0.0001). Thoracic duct ligation was successful in 44 of 52 patients that proceeded to the operating room (85{\%}). Of the 40 patients undergoing diagnostic lymphangiography, a leak was identified in 34 (85{\%}), but the cisterna chyli could only be cannulated in 19 (48{\%}) and was subsequently successful in 15 (38{\%}). Conclusions: Patients with chylous chest tube outputs of 1,100 mL or more in 24 hours postoperatively should be considered for intervention. Intention-to-treat analysis shows surgical duct ligation is more effective than thoracic duct embolization, with the ability to cannulate the cisterna chyli being the limiting factor. Lymphangiography may help determine which patients are better treated with ligation or embolization.",
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