249. CLINICAL IMPLICATIONS OF CHYLE LEAKAGE FOLLOWING ESOPHAGECTOMY

Abstract

Abstract For esophageal malignancies, leading oncological centers advocate transthoracic esophagectomy, including routine en-bloc resection of the thoracic duct for adequate mediastinal lymphadenectomy. However, as a result of injury to the main thoracic duct or its collateral branches during resection, this can lead to chyle leakage. The short-term 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 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 included 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 feeding (2%). There were no re-interventions for chyle leakage during initial admission, although one patient needed additional pleural drainage during re-admission. 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 frequently occurring complication following esophagectomy with resection of the thoracic duct and extensive lymphadenectomy, with substantial clinical consequences. Even though non-surgical treatment was successful in all patients with chyle leakage in this series, chyle leakage impeded postoperative recovery. Future research should focus on reducing the incidence of chyle leakage after esophageal surgery.