Abstract
Background: Chylothorax (CHT) is a known post-operative complication after esophageal surgery with vaguely defined risk factors.Methods: This is a retrospective chart review of 70 consecutive patients with operable cancer over a period of four years (January 2013 to December 2016). Ivor Lewis and McKeown interventions were performed. Thoracic duct is identified and ligated routinely. Factors related to the patient, the tumor, and the operating surgeon were analyzed.Results: Incidence of CHT was 10%. Surgeons with less than five years of esophageal surgery experience had the most CHT, 71% (p=0.001). No association was found between tumor location, type, body mass index (BMI), neoadjuvant therapy, response to neoadjuvant therapy or male sex, and CHT. The odds of developing CHT were 17 times higher in patients operated by a junior surgeon (odds ratio, OR=17.67, confidence interval, CI 2.68-116.34, p=0.003). Four patients (5.7%) had anastomotic leaks, none of them had CHT. Senior surgeons had less operative time and harvested more lymph nodes (p=0.0002 and p=0.1086 respectively).Conclusion: Surgeon’s experience might be considered a major risk factor to develop CHT. This finding needs to be confirmed by a larger multicentric series taking into consideration the human factor.
Highlights
Chylothorax (CHT) is the accumulation of lymphatic fluid in the pleural cavity
Surgeon’s experience might be considered a major risk factor to develop CHT. This finding needs to be confirmed by a larger multicentric series taking into consideration the human factor
Univariate analysis (Table 2) showed that the tumor location at the lower third of the esophagus and adenocarcinoma was associated with 71% of Group B (p=0.107 and p=0.14 respectively)
Summary
Chylothorax (CHT) is the accumulation of lymphatic fluid in the pleural cavity. Its incidence after esophageal operations varies between 0.9% and 11.6% in the literature [1,2,3]. Different studies have discussed and researched the risk factors for developing CHT after esophageal and cardiopulmonary interventions including factors related to the patient, their treatment regimen, and the tumor [4,5]. Between post-operative complications, CHT is an important entity, it has relatively low incidence rates. Methods of treatment start with fasting in addition to the modification of enteral or parenteral feeding using mediumchain triglyceride products. If this is not sufficient, various other solutions exist, ranging from octeroid agonists, radiological embolization of the thoracic duct, and as a last solution, a reoperation to religate the thoracic duct [1, 4]. Chylothorax (CHT) is a known post-operative complication after esophageal surgery with vaguely defined risk factors
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