Postoesophagectomy chylothorax: A single‐centre, 14‐year review

• Published in: Surgical practice 2019-08, Vol.23 (3), p.87-94
• Main Authors: Lo, Samuel Tsoon‐Wuan, Lam, Kar‐Hei, Lam, Hiu‐Ying, Wong, Kevin Ka‐Fai, Leung, Siu‐Kee
• Format: Article
• Language: English
• Subjects: chyle; chylothorax; Morbidity; oesophagectomy; Ostomy; postoperative complication
• ISSN: 1744-1625; 1744-1633
• DOI: 10.1111/1744-1633.12365

Aim The reported incidence of postoesophagectomy chylothorax is 1.2–4 per cent. The diagnosis is based on clinical suspicion: milky chest drain fluid and/or high volume chest drain output. Confirmatory tests involve sending fluid for laboratory investigations. Chylothorax is a potentially lethal condition and carries a high morbidity rate. An early diagnosis can potentially help to identify those who might require operation, dietary restrictions or other treatments. The aim of the present study was to evaluate chylothorax in postoesophagectomy patients. Patients and Methods We extracted data from patients who underwent oesophagectomy at Tuen Mun Hospital from 2004 to 2018 for the present retrospective study. Chest drain fluid from every patient was sent every postoperative day for testing for chyle, regardless of quantity and whether or not it was milky. The characteristics of the patients, disease, operations, perioperative conditions, postoperative complications, hospital stay, interventions, morbidity and mortality and chest drain outputs were compared. Results The incidence of chylothorax in our cohort was 9 per cent (14/155). There were nine biochemical chyle leaks (64.3 per cent) and five clinical leaks (35.7 per cent). The biochemical leakage group had a significantly higher 1‐month morbidity rate compared to the nonchylothorax patients (89.9 vs 50 per cent, P = 0.03). All biochemical leaks were resolved with conservative management. The entire chylothorax group also had a longer hospital stay (25.5 vs 17 days, P = 0.04) compared to the nonchylothorax group. Thoracotomy was done in two patients with clinical leaks, and the remaining leaks were resolved with conservative management. In subgroup analysis, the biochemical leak subgroup was found to have a higher 1‐month morbidity rate (88.9 versus 50 per cent, P = 0.03) compared to the nonchylothorax group. Conclusion By routinely screening for chylothorax, the incidence was found to be 9 per cent, higher than that reported in the literature. The biochemical leak subgroup was found to have a higher 1‐month morbidity rate. This could suggest that biochemical leakage of chyle might have a clinical impact on the recovery of postoesophagectomy patients.