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Prophylactic ligation of the thoracic duct in the prevention of chylothorax after esophagectomy

Česká verzia

Authors: T. Jínek 1;  L. Adamčík 1;  M. Duda 1,2;  P. Buzrla 3;  M. Škrovina 1,4
Authors place of work: Chirurgické oddělení Nemocnice Nový Jičín, a. s., Centrum vysoce specializované onkologické péče pro dospělé Nový Jičín, Vzdělávací a výzkumný institut AGEL, o. p. s. 1;  II. chirurgická klinika Lékařské fakulty Univerzity Palackého a Fakultní nemocnice Olomouc 2;  Laboratoře AGEL a. s. Nový Jičín, Patologie 3;  I. Chirurgická klinika Lékařské fakulty Univerzity Palackého a Fakultní nemocnice Olomouc 4
Published in the journal: Rozhl. Chir., 2018, roč. 97, č. 7, s. 328-334.
Category: Original articles

Summary

Introduction:

Chylothorax after esophageal resection is an uncommon but serious complication with a reported incidence of 1−10%. It occurs after the injury of the thoracic duct or its tributaries. Chylothorax may cause an overall loss of several liters per day and may lead to dehydration, malnutrition and immunosuppression. Therapeutic approach has not been standardized. Prophylactic ligation of the thoracic duct during primary resection has been introduced to decrease the overall incidence of chylothorax. Its oncological benefit is unknown.

Method:

A retrospective single-center study of patients who underwent transthoracic esophagectomy from 2008−2016 for esophageal carcinoma at the Department of Surgery, Hospital Nový Jičín. 58 patients underwent transthoracic esophagectomy (Ivor-Lewis and McKeown). Prophylactic ligation of the thoracic duct was performed in 31 patients (53%). The incidence of chylothorax and the amount of harvested lymph nodes was analysed in the group with thoracic duct ligation (A PTDL 31 patients) and in the non-ligation group (B 27 patients).

Results:

Overall incidence of chylothorax after transthoracic esophagectomy was 3.4%. Chylothorax occurred in two men (type 3B) in the prophylactic group (6.5%) and it was not observed in the non-ligation group. Statistically significant difference was not confirmed (p=0,494). Chylous leak was successfully treated thoracoscopically and by thoracotomy with repeat ligation of the thoracic duct. Non-significantly more lymph nodes were harvested in the prophylactic group (18 A PTDL vs. 15 B, p=1).

Conclusion:

Prophylactic ligation of the thoracic duct in our study did not reduce the incidence of chylothorax. Redo thoracotomy and redo thoracoscopy for chylothorax is feasible. In patients with high-output and long lasting leaks the indication for redo surgery should be early.

Key words:

chylothorax − esophageal resection − prophylactic thoracic duct ligation

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Štítky
Surgery Orthopaedics Trauma surgery
Článek The use of retrosternally placed colon in esophageal replacement
Článek Current state of surgical treatment of cancer of the stomach and gastro-esophageal junction in the Czech Republic
Článek Hybrid thoracoscopic esophagectomy for cancer – retrospective analysis and comparison with transhiatal resection
Článek Esophageal cancer − results of surgical treatment at the Department of Surgery I. at the University Hospital Olomouc
Článek Successfull therapy of grade III leak after thoracic oesophagectomy
using endoscopic vacuum assisted closure therapy – a case study
Článek Results of minimally invasive esophagectomy for esophageal cancer performed after ischemic gastric conditioning
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Perspectives in Surgery

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