Abstract
BackgroundManagement of postoperative chylothorax generally involves nutritional regimens as well as pharmacological and surgical therapies, but a clear consensus has yet to be reached.MethodsRetrospective review of 371 patients who underwent esophagectomy for esophageal cancer was performed. They were patients with squamous cell carcinoma or adenocarcinoma of the esophagus including Siewert type I/II tumor of the esophagogastric junction who underwent subtotal esophagectomy. Of these patients, 19 patients who were diagnosed with chylothorax as a postoperative complication were enrolled in this study.ResultsConservative treatment achieved cure in 16 patients among 19 patients. The duration of chylothorax tended to be longer in the no-etilefrine group (n = 5) than in the etilefrine group (n = 11) (27.8 vs. 11.6 days; p = 0.078). The 14 patients among 19 patients resected the thoracic duct. Etilefrine was used in 12 of these 14 patients. Among these 12 patients, 3 required surgical treatment and the remaining 9 patients were cured with conservative treatment. The duration of chylothorax was shorter in the conservative treatment group than in the surgical treatment group (11.9 vs. 36.3 days; p = 0.052). In addition, with the use of etilefrine as adjuvant therapy, cure was achieved in 9 patients (75%) without surgical intervention.ConclusionsThe findings of this study suggest that when used concurrently with conventional treatments, etilefrine facilitates early chest tube removal. In addition, post-thoracic duct resection chylothorax, which frequently requires surgical treatment because of the general less effectiveness of conservative treatments, showed high successful rate (75%) to etilefrine treatment.
Highlights
Postoperative chylothorax after esophagectomy occurs relatively infrequently, in about 2–9% of patients [1,2,3]
We investigated the usefulness of an etilefrine regimen to broaden the medical treatment options for postoperative chylothorax after esophagectomy with resection of the thoracic duct
We investigated the clinical effectiveness of etilefrine for the management of postoperative chylothorax following esophagectomy among patients with resection of the thoracic duct
Summary
Postoperative chylothorax after esophagectomy occurs relatively infrequently, in about 2–9% of patients [1,2,3]. Previous reports have noted the difficulty of using only medical management consisting of a nutritional regimen, etilefrine, octreotide, and picibanil (OK-432) for patients who have undergone thoracic duct resection, and that these therapies for chylothorax were indicated only for those patients in whom the thoracic duct was preserved [5,6,7,8]. Methods Retrospective review of 371 patients who underwent esophagectomy for esophageal cancer was performed They were patients with squamous cell carcinoma or adenocarcinoma of the esophagus including Siewert type I/II tumor of the esophagogastric junction who underwent subtotal esophagectomy. Of these patients, 19 patients who were diagnosed with chylothorax as a postoperative complication were enrolled in this study.
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