Analysis of related factors and treatment effect of chylothorax after lung surgery

Abstract

Background: Chylothorax is a seldom encountered complication following lung surgery. However, due to the widespread practice of lung surgery, postoperative complications have inevitably arisen. Chylothorax significantly affects a patient's discharge and recovery. This study investigates the risk factors for postoperative chylothorax at our center and analyzes various treatment modalities and prognostic outcomes.

Methods: A retrospective analysis was conducted on all postoperative lung resections performed between January 2018 to August 2021 that met the inclusion criteria. Inclusion criteria covered patients undergoing various thoracic surgeries for lung conditions, while exclusion criteria included postoperative referrals for surgeries unrelated to lung tumors.

Results: Postoperative chylothorax occurred in 42 of 5,706 patients after lung surgery. General information and disease-related data of the chylothorax and control group were analyzed by univariate and multivariate analyses. Multivariate analysis showed that serum albumin before surgery [odds ratio (OR) =0.86, 95% confidence interval (CI): 0.81-0.91, P<0.001], γ-glutamyl transferase level before surgery (after logarithmic transformation, OR =1.01, 95% CI: 1.00-1.01, P=0.01), squamous cell carcinoma (OR =2.77, 95% CI: 1.37-5.6, P=0.008), right mediastinal lymph node dissection (OR =3.15, 95% CI: 1.62-6.14, P<0.001) were independent risk factors for postoperative chylothorax. Among the 42 cases of postoperative chylothorax, 26 patients were improved with conservative treatments, and 6 patients were improved with chemical pleurodesis. Eight patients with postoperative chylothorax underwent thoracoscopic thoracic duct ligation. Three patients experienced severe postoperative complications: one was discharged after prolonged treatment, while the remaining two either succumbed or were discharged against medical advice.

Conclusions: The incidence of chylothorax after lung surgery closely correlates with the intraoperative trauma and nutritional status of patients during the perioperative period. The majority of patients with postoperative chylothorax experienced relief through conservative measures, somatostatin administration, and chemical pleurodesis. Nevertheless, substantial postoperative chylothorax necessitated surgical intervention, involving thoracic duct ligation or drug pleurodesis.

Keywords: Chylothorax; lung surgery; postoperative complications; risk factors.

Figure 1

The treatment strategy flowchart in this study. PN, parenteral nutrition; VATS, video-assisted thoracoscopic surgery.

Figure 2

Photos from two patients’ drainage fluid diagnosed as postoperative chylothorax (A,B). Drainage fluid is often milky white or creamy due to the presence of chyle, a lipid-rich lymphatic fluid.

Figure 3

Differences in preoperative and postoperative day 1 laboratory indicators. ALB, albumin; BF, preoperative day; AF1, postoperative day 1; GGT, γ-glutamyl transferase; CRP, C-reactive protein.

Figure 4

ROC curve of the logistic regression. AUC, area under the curve; ROC, receiver operating characteristic.

Figure 5

Photo from one of the VATS thoracic duct ligation procedures. During the surgery, a residual branch of the thoracic duct was observed above the right brachiocephalic vein arch, and a grayish-white oily fluid was seen flowing out. After precise localization, titanium clips were used for closure, and the surgery was concluded after observing no significant fluid leakage for 30 minutes. VATS, video-assisted thoracoscopic surgery.