Clinical implications of chyle leakage following esophagectomy

• Published in: Diseases of the esophagus 2023-01, Vol.36 (2)
• Main Authors: Schafrat, Pascale J M, Henckens, Sofie P G, Hagens, Eliza R C, Eshuis, Wietse J, Gisbertz, Suzanne S, Laméris, Wytze, van Berge Henegouwen, Mark I
• Format: Article
• Language: English
• Subjects: Chyle; Chylothorax - complications; Chylothorax - therapy; Esophagectomy - adverse effects; Humans; Original; Postoperative Complications - surgery; Postoperative Complications - therapy; Retrospective Studies; Thoracic Duct - surgery; Triglycerides
• ISSN: 1120-8694; 1442-2050; 1442-2050
• DOI: 10.1093/dote/doac047

The clinical consequences of chyle leakage following esophagectomy are underexposed. The aim of this study was to investigate the clinical implications of chyle leakage following esophagectomy. This retrospective study of prospectively collected data included patients who underwent transthoracic esophagectomy in 2017-2020. Routinely, the thoracic duct was resected en bloc as part of the mediastinal lymphadenectomy. Chyle leakage was defined as milky drain fluid for which specific treatment was initiated and/or a triglyceride level in drain fluid of ≥1.13 mmol/L, according to the Esophagectomy Complications Consensus Group (ECCG) classification. Primary endpoints were the clinical characteristics of chyle leakage (type, severity and treatment). Secondary endpoints were the impact of chyle leakage on duration of thoracic drainage and hospital stay. Chyle leakage was present in 43/314 patients (14%), of whom 24 (56%) were classified as severity A and 19 (44%) as severity B. All patients were successfully treated with either medium chain triglyceride diet (98%) or total parental nutrition (2%). There were no re-interventions for chyle leakage during initial admission, although one patient needed additional pleural drainage during readmission. Patients with chyle leakage had 3 days longer duration of thoracic drainage (bias corrected accelerated (BCa) 95%CI:0.46-0.76) and 3 days longer hospital stay (BCa 95%CI:0.07-0.36), independently of the presence of other complications. Chyle leakage is a relatively frequent complication following esophagectomy. Postoperative chyle leakage was associated with a significant longer duration of thoracic drainage and hospital admission. Nonsurgical treatment was successful in all patients with chyle leakage.