Postoperative Chylothorax after Modified Radical Neck Dissection for Thyroid Carcinoma: A Missable Rare Complication of Thyroid Surgery

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2020-09, Vol.56 (9), p.481
• Main Authors: Lee, Junghyun, Bae, In Eui, Yoon, Jin, Lee, Keunchul, Yu, Hyeong Won, Kim, Su-Jin, Chai, Young Jun, Choi, June Young, Lee, Kyu Eun
• Format: Article
• Language: English
• Subjects: Chylothorax - epidemiology; Chylothorax - etiology; Humans; modified radical neck dissection; Neck Dissection - adverse effects; papillary thyroid cancer; postoperative chylothorax; postoperative complication; Postoperative Complications - epidemiology; Retrospective Studies; Thyroid Neoplasms - surgery; thyroidectomy
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina56090481

: Currently, few studies have been conducted on postoperative chylothorax, specifically in total thyroidectomy with modified radical neck dissection (MRND) in papillary thyroid carcinoma patients. This study provides the actual incidence, etiology, and clinical features of postoperative chylothorax and reports the clinical outcomes after treatment, which were dependent upon the severity of the complications. : The medical charts of 111 papillary thyroid cancer (PTC) patients who underwent total thyroidectomy with modified radical neck dissection from January 2016 to December 2018 were reviewed retrospectively. The results were compared in three groups: the no chylothorax group, the subclinical (asymptomatic) group, and the clinical (symptomatic) group. Chylothorax occurred in 23 patients (20.7%, 23/111). Nineteen (82.6%, 19/23) were subclinical chylothorax cases, which implies a small amount of chyle leakage with no respiratory symptoms. Four (17.4%, 4/23) were clinical, meaning they had either respiratory symptoms, such as dyspnea, desaturation, or a large amount of chylothorax in the images. The incidence was significantly higher in patients who underwent left modified radical neck dissection, and this corresponds to the side in which chylothorax occurred. There were also statistical differences in the drainage color, peak amount, or drain removal time. Postoperative chylothorax is a rare complication following neck dissection. However, it can be fatal if the condition progresses. Therefore, patients who undergo total thyroidectomy with modified radical neck dissection, especially on the left side, should be monitored for respiratory symptoms, and serial chest x-ray images obtained.