Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Mar;93(3):897-903; discussion 903-4.
doi: 10.1016/j.athoracsur.2011.10.060. Epub 2012 Jan 15.

Postesophagectomy chylothorax: incidence, risk factors, and outcomes

Rachit D Shah  1 , James D Luketich, Matthew J Schuchert, Neil A Christie, Arjun Pennathur, Rodney J Landreneau, Katie S Nason
Affiliations

Postesophagectomy chylothorax: incidence, risk factors, and outcomes

Rachit D Shah et al. Ann Thorac Surg. 2012 Mar.

Abstract

Background: Chylothorax is a rare but potentially lethal complication of esophagectomy. This study evaluated the rate of postesophagectomy chylothorax, identified associated risk factors, and compared postoperative outcomes in patients with and without chylothorax.

Methods: We reviewed 892 consecutive patients who underwent esophagectomy (1997 to 2008). Preoperative, operative, and postoperative details, including adverse outcomes and mortality, were analyzed.

Results: Postesophagectomy chylothorax occurred in 34 patients (3.8%). Chylothorax was significantly associated with 30-day major complications (85% vs 46%; p<0.001), including an increased likelihood of sepsis (p=0.001), pneumonia (p=0.009), reintubation (p=0.002) or reoperation (p<0.001), and death (17.7% vs 3.9%, p<0.001). Median length of stay was 17 vs 8 days (p=0.005). Median time to chylothorax diagnosis was 5 days. Thoracic duct ligation was performed in 21 (62%) at a median 13 days after esophagectomy. Two patients required repeat duct ligation for persistent chylothorax. Squamous cell cancer histology (9 of 34; 26%) was an independent predictor of postoperative chylothorax (odds ratio, 4.18; 95% confidence interval, 1.39 to 12.6). Odds of chylothorax were 36 times greater with average daily chest tube output exceeding 400 mL in the first 6 postoperative days (odds ratio, 35.9; 95% confidence interval, 8.2 to 157.8).

Conclusions: Postoperative chylothorax is associated with significant postoperative morbidity and mortality. Patients with squamous cell cancer may be at increased risk. In addition, average daily chest tube output exceeding 400 mL in the early postoperative period should prompt fluid analysis for chylothorax to facilitate early diagnosis and consideration of thoracic duct ligation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Chest tube output of patients with postesophagectomy chylothorax. The dashed line indicates the cut-off value of 11.6 ml/kg average daily chest tube output for high risk of failed medical therapy.
See this image and copyright information in PMC

Comment in

References

    1. Cagol M, Ruol A, Castoro C, Alfieri R, Michieletto S, Ancona E. Prophylactic thoracic duct mass ligation prevents chylothorax after transthoracic esophagectomy for cancer. World journal of surgery. 2009;33:1684–1686. - PubMed
    1. Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative chylothorax. J Thorac Cardiovasc Surg. 1996;112:1361–1365. discussion 1365-1366. - PubMed
    1. Cope C. Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study. J Vasc Interv Radiol. 1998;9:727–734. - PubMed
    1. Cope C, Salem R, Kaiser LR. Management of chylothorax by percutaneous catheterization and embolization of the thoracic duct: prospective trial. J Vasc Interv Radiol. 1999;10:1248–1254. - PubMed
    1. Crandall LJ, Barker S, Graham D. A study of the lymph from a patient with thoracic duct fistula. Gastroenterology. 1943;1:1040–1042.

Publication types