Chylothorax Research Articles

Chylothorax (CT) is a rare yet serious complication after esophagectomy. Identification of the thoracic duct (TD) during esophagectomy is challenging due to its anatomical variation. Real-time identification of TD may help to prevent its injury. Near infra-red imaging with Indocyanine green (ICG) is a novel technique that recently has been used to overcome this issue. Patients who underwent minimally invasive esophagectomy for esophageal cancer were divided into two groups with and without ICG. We injected ICG into bilateral superficial inguinal lymph nodes. Identification of TD and its injuries during the operation was evaluated and compared with the non-ICG group. Eighteen patients received ICG, and 18 patients underwent surgery without ICG. Each group had one (5.5%) TD ligation. In the ICG group injury was detected intraoperative, and ligation was done at the site of injury. In all cases, the entire thoracic course of TD was visualized intraoperatively after a mean time of 81.39 min from ICG injection to visualization. The Mean extra time for ICG injection was 11.94 min. In the ICG group, no patient suffered from CT. One patient in the non-ICG group developed CT after surgery that was managed conservatively. According to Fisher's exact test, there was no significant association between CT development and ICG use, possibly due to the small sample size. This study confirms that ICG administration into bilateral superficial inguinal lymph nodes can highlight the TD and reduce its damage during esophagectomy. It can be a standard method for the prevention of postoperative CT.

Background: Chyloperitoneum (CP) and chylothorax (CT) are rare conditions that have a high mortality rate and unclear treatment options. Their incidence in neonates ranges from 1 in 20000 to 1 in 187000 live births. This study aims to evaluate the effectiveness of synthetic somatostatin analog (octreotide) and sirolimus therapy in treating chylous pleural and peritoneal collections in newborns and infants. Methods: We conducted a retrospective analysis of 10 children with either chylothorax or chyloperitoneum, treated in our department between 2018 and 2023. The study was approved by the Local Independent Ethics Committee of The National Medical Research Center of Children's Health, under Protocol №7, dated 11 May 2023. The parents voluntarily signed an informed consent form for the off-label use of the drug. We reviewed the medical records for demographic information, clinical presentation, management, and outcome. Results: Our study looked at patients aged between 0 and 5.5 months, with seven cases of chyloperitoneum and three cases of chylothorax. We initially used octreotide, which was then switched to sirolimus if there was no improvement. Octreotide was effective in five children after 10-18 days of treatment, while the effect of sirolimus was observed 8-14 days after starting treatment. One patient, who had a history of a giant omphalocele with primary closure, experienced complications after 8 weeks of sirolimus therapy, including bilateral knee arthritis, leukopenia, and lymphopenia. Fortunately, there were no fatal outcomes. Conclusion: Sirolimus therapy is effective in treating newborns with chylothorax or chyloperitoneum, with a low risk of complications even in those cases not responding to octreotide therapy. It is recommended that octreotide therapy should not exceed 10 days, after which sirolimus can be prescribed.

Background: Chyloperitoneum (CP) and chylothorax (CT) are rare conditions that have a high mortality rate and unclear treatment options. Their incidence in neonates ranges from 1 in 20000 to 1 in 187000 live births. This study aims to evaluate the effectiveness of synthetic somatostatin analog (octreotide) and sirolimus therapy in treating chylous pleural and peritoneal collections in newborns and infants. Methods: We conducted a retrospective analysis of 10 children with either chylothorax or chyloperitoneum, treated in our department between 2018 and 2023. The study was approved by the Local Independent Ethics Committee of The National Medical Research Center of Children's Health, under Protocol №7, dated 11 May 2023. The parents voluntarily signed an informed consent form for the off-label use of the drug. We reviewed the medical records for demographic information, clinical presentation, management, and outcome. Results: Our study looked at patients aged between 0 and 5.5 months, with seven cases of chyloperitoneum and three cases of chylothorax. We initially used octreotide, which was then switched to sirolimus if there was no improvement. Octreotide was effective in five children after 10-18 days of treatment, while the effect of sirolimus was observed 8-14 days after starting treatment. One patient, who had a history of a giant omphalocele with primary closure, experienced complications after 8 weeks of sirolimus therapy, including bilateral knee arthritis, leukopenia, and lymphopenia. Fortunately, there were no fatal outcomes. Conclusion: Sirolimus therapy is effective in treating newborns with chylothorax or chyloperitoneum, with a low risk of complications even in those cases not responding to octreotide therapy. It is recommended that octreotide therapy should not exceed 10 days, after which sirolimus can be prescribed.

Introduction: Superior cavopulmonary anastomosis (SCPC) inevitably exposes the thoracic duct to higher venous pressure, potentially triggering disordered lymphatic perfusion manifesting as chylothorax (CT) and/or plastic bronchitis (PB) . Though outcomes following lymphatic interventions after Fontan completion (FC) are well described, they are not well described in patients after SCPC. Methods: A single-center retrospective study of patients who underwent lymphatic intervention for PB or CT following SCPC 1/1/2011-12/31/2021 was performed, excluding those with planned two ventricle or 1.5 ventricle repair, patients who underwent thoracic duct ligation, and those in whom interventions were performed either prior to SCPC or following FC. Results: In total, 27 patients (56% male) were studied, of which 22% had PB and 78% with CT, 7% with Noonan’s syndrome and 19% with heterotaxy syndrome. Median age at intervention was 11.3 months (IQR 7.4 - 33.5). Median time following SCPC was 3.5 months (IQR 2.1 - 24.2). In terms of interventions, 41% (n=11) underwent selective lymphatic channel embolization. Of these 36% (4/11) underwent subsequent thoracic duct embolization (TDE). The remaining 59% (n=16) patients underwent TDE. The thoracic duct was able to be accessed in 23 patients (85.2%). Twenty-four patients (19/21 with CT, 5/6 with PB) had resolution of symptoms following transcatheter intervention at our center. Following intervention, seven patients (all of whom were of the type IV lymphatic subtype) were successfully referred for FC, ten are currently awaiting FC, five are not Fontan candidates and five passed away from non-procedural comorbidities. Median duration of post-operative chest tubes following FC was 7 days (IQR 6-8) and median follow up is 39.1 months (IQR 15.1 - 45.1). Conclusions: Selective lymphatic embolization and TDE are feasible in SCPC recipients with CT and PB, with most patients experiencing symptomatic improvement. Subsequent FC has been achieved in some patients with type IV lymphatic abnormalities, suggesting that these interventions may alter the unnatural history of lymphatic dysfunction in single ventricle patients. Future research is needed to define longer term outcomes of this high-risk cohort.

Thoracic duct (TD) is the largest lymphatic vessel in the body and drains the lymph at the junction between the left subclavian and jugular veins. Chylothorax (CTX) represents an accumulation of lymphatic fluid in the pleural space. We present a case of a 65 years-old man with an histologically diagnosed mediastinal type B non-Hodgkin Lymphoma, treated with chemo-immunotherapy. CT scan during follow up showed significant left side pleural effusion, amounting to 2.8 litres after drainage. Conservative treatment with low fat parenteral nutrition was started without reduction of drainage output, then lymphangiography (LP) with Lipiodol was performed demonstrating a leak in the distal TD. CTX increased in the following days, and a further LP was performed. Using transvenous retrograde access we catheterized TD at the left subclavian jugular veins using a microcatheter. The leak was treated with multiple conventional and controlled delivery microcroils and cyanoacrylate, obtaining complete embolization without residual leak.

Chylothorax (CTx) is the leak and accumulation of lymphatic fluid within the pleural cavity. The incidence of CTx has the highest rate after esophagectomy. This study aimed to present three cases of post-esophagectomy chylothorax among 612 esophagectomies that were performed over 19 years, in which post-esophagectomy chylothorax was reviewed in terms of risk factors, diagnosis, and management. Six hundred and twelve patients were included in the study. Transhiatal esophagectomy was used for all patients. In three cases, chylothorax was detected. In all of the three cases, secondary surgery was performed for the management of chylothorax. Mass ligation was performed for the first and third cases having leak from the right side. In the second case, the leak was from the left side without prominent duct; and despite mass ligation that was done several times, no significant reduction in chyle was observed. In the first case, in spite of reduced output, the patient gradually progressed to respiratory distress. His condition deteriorated over time and he died after three days. In the second case that needed third surgery, the patient's condition deteriorated and she died after two days due to respiratory failure. The third patient had postoperative recovery. The patient was discharged on fifth day after the second operation. In post-esophagectomy chylothorax, the key to preventing high mortality rates can be the identification of risk factors as well as timely detection of symptoms and proper management. Besides, early surgical intervention should be considered to prevent early complications of chylothorax.

Esophagectomy for cancer is one of the most complex procedures in visceral surgery. Postoperative complications negatively affect the patient's overall survival. They are not influenced by the histology type (adenocarcinoma (AC)/squamous cell carcinoma (SCC)), or the surgical approach (open, laparoscopic, or robotic-assisted). Among those dreadful complications are anastomotic leak (AL), esophago-respiratory fistula (ERF), and chylothorax (CT). In this review, we summarize the methods to avoid these complications, the diagnostic approach, and new therapeutic strategies. In the last 20 years, both centralization of the medical care, and the development of endoscopy and radiology have positively influenced the management of postoperative complications. For the purpose of their prevention, perioperative measures have been applied. The treatment includes conservative, endoscopic, and surgical approaches. Post-esophagectomy complications are common. Prevention measures should be known. Early recognition and adequate treatment of these complications save lives and lead to better outcomes.

Objetivo: relatar um caso de quilotórax bilateral após esvaziamento cervical devido a carcinoma de língua, complicação rara descrita 65 vezes na literatura. Detalhamento do caso: mulher, 63 anos, atendida no ambulatório de cirurgia de cabeça e pescoço com grande lesão vegetante em borda lateral esquerda da língua, a biopsia incisional diagnosticou carcinoma espinocelular, paciente então foi encaminhada para realizar glossectomia parcial à esquerda associado a esvaziamento cervical radical tipo 2 à esquerda e esvaziamento cervical supra homoióideo à direita. Evoluiu com dispneia moderada no 2º dia pós operatório, através do exame físico, radiografia de tórax e análise do líquido pós toracocentese foi diagnosticado quilotórax bilateral, uma complicação extremamente rara, uma vez que não houve lesão do ducto torácico. Considerações finais: trata-se de uma complicação rara e importante, o melhor método para minimizar as consequências e a taxa de morbidade é o diagnóstico precoce. Logo, deve-se aprimorar os registros na literatura e o manejo clínico cirúrgico e clínico a fim de obter prognóstico melhor desses pacientes.

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.

Abstract Background Chylous ascites is a debilitating condition characterized by milky, triglyceride-rich fluid accumulating in the peritoneum due to disruption of the intraabdominal lymphatic system. Medical management includes low-fat diets, somatostatin analogues, and therapeutic paracentesis, but is unsuccessful in one-third of patients. Methods We present a 59-year-old man with massive chylous ascites and chylothorax secondary to chronic pancreatitis, who failed medical therapies for nearly two years, before being successfully treated with a novel surgical technique. Demographic and clinical data were obtained from the electronic medical record at Massachusetts General Hospital from 2015 to 2019. Patient information was kept anonymous and informed consent was obtained for publication of this report. Results Based on a previously published small case series, we created a vascularized lymphatic cable flap based on the superior epigastric vessels, which we anastomosed to mesenteric vessels, permitting chylous drainage superiorly through the thoracic duct. With two years of follow-up, our patient has no evidence of recurrent ascites or chylothorax, and robust nutritional and functional status. Conclusion We present this novel surgical technique as a promising intervention for patients with chylous ascites and/or chylothorax who have failed medical management.

目的 探讨伴腹部巨大包块及乳糜胸的滤泡性淋巴瘤（FL）的临床特点、诊断及治疗情况。 方法 对兰州军区兰州总医院收治的1例伴腹部巨大包块及乳糜胸的FL患者的相关实验室检查、影像学、病理学检查及治疗情况进行回顾性分析，并复习相关文献。 结果 该患者临床主要表现为反复出现的乳糜胸，盆腔磁共振成像示腹膜后巨大占位，结合各项实验室检查及颈部淋巴结活组织检查明确诊断为非霍奇金淋巴瘤，滤泡细胞型ⅣB期，后给予R-CHOP方案定期化疗。 结论 FL典型的临床表现为无痛性淋巴结肿大，出现原因不明的腹部巨大包块，乳糜胸相对少见，应根据病情及早行骨髓穿刺等综合性检查，避免误诊、漏诊。

Lymphangioleiomyomatosis (LAM) is a rare progressive cystic lung disease, most prevalent in women, which affects the lung function, axial lymphatics and causes angiomyolipomas. Progressive dyspnea, pneumothorax, chylous effusions and cough are some of the clinical manifestations. It is a disease that can be difficult to manage and can have a poor prognosis, especially if not promptly addressed. We present a case report of a 43-year-old woman who was admitted in 2014 with recurrent chylothorax and diagnosed with LAM. However, since the actual best therapeutic approach, sirolimus, was not yet recommended at the time, together with the patient

Objective To explore the application value of cone-shaped gastric tube combined with cervical end-to-end anastomosis in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Methods The retrospective and descriptive study was conducted. The clinical data of 122 patients with esophageal cancer who were admitted to West China Hospital of Sichuan University from December 2016 to December 2017 were collected. There were 89 males and 33 females, aged (61±8)years, with a range from 48 to 81 years. McKeown-type three-incision esophagectomy was performed, and the cone-shaped gastric tube was pulled up to esophagus in left neck for hand-sewn end-to-end anastomosis after the dissection of esophagus and stomach under total thoracoscopy and laparoscopy. Observation indicators: (1) surgical treatment situations; (2) postoperative complications; (3) follow-up. Follow-up using outpatient examination was performed to detect postoperative gastroesophageal reflux, anastomotic stenosis and evaluate anastomotic width at 1, 3, 6 months and one year postoperatively up to December 2018. Measurement data with normal distribution were represented by Mean±SD. Measurement data with skewed distribution were described by M (P25, P75) or M (range). Count data were expressed by absolute number. Results (1) Surgical treatment situations: 122 patients underwent laparocopic McKeown-type three-incision esophagectomy successfully, using cone-shaped gastric tube combined with cervical hand-sewn end-to-end anastomosis as digestive tract reconstruction, with no intraoperative conversion to open surgery. The operation time, cervical anastomosis time, and volume of intraoperative blood loss were (229±49)minutes, (27±1)minutes, and 50 mL (40 mL, 60 mL), respectively. There were 6-8 stations of lymph node dissected, and the number of lymph node dissected were 19 (15, 25). Duration of postoperative hospital stay was 10 days (9 days, 11 days) in the 122 patients. (2) Postoperative complications: 31 of 122 patients had postoperative complications. The primary complications: 3 patients with anastomotic fistula were cured by conservative treatment including enteral nutrition through placement of nutritional tube under gastroscope, closed thoracic drainage and anti-infection; 6 cases with severe thoracic gastric dilation were cured after gastrointestinal decompression. The secondary complications of 22 patients included 8 cases with hoarseness caused by recurrent laryngeal never injury, 5 with arrhythmia, 9 with pulmonary infection. They were cured after symptomatic and supportive treatment. No chylothorax occured, and there was no perioperative death. (3) Follow-up: all the 122 patients were followed up for 10-24 months, with a median time of 19 months. During the follow-up, 7 cases with anastomotic stenosis including 4 scoring less than grade 2 and 3 scoring more than grade 3 were relieved after dilation through gastroscope. There were 33 of 122 patients without any reflux symptoms, and 89 with reflux symptoms, among which 52 were scored 1, 25 were scored 2 and 12 were scored 3. The width of gastroesophageal anastomosis measured by barium radiography at 1 month after operation was (1.2±0.4)cm. Conclusion Cone-shaped gastric tube combined with cervical end-to-end anastomosis in digestive tract reconstruction of thoracoscopic and laparoscopic esophagectomy can reduce the incidence of postoperative anastomotic complications and thoracic gastric dilation, and nasogastric tube placement could be abandoned, which demonstrates good safety and universality. Key words: Esophageal neoplasms; Esophageal cancer; Esophagectomy; Cone-shaped gastric tube; Hand-sewn anastomosis; End-to-end anastomosis; Thoracoscopy; Laparoscopy

Objective To investigate the application value of closed single-port thoracoscopic and laparoscopic radical esophagectomy for esophageal cancer. Methods The retrospective and descriptive study was conducted. The clinical data of a 49-year-old male patient with esophageal cancer who was admitted to the Fujian Medical University Union Hospital in November 2018 were collected. The patient underwent closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection. In the thoracic part, esophageal separation and thoracic lymph node dissection were performed with closed pneumothorax, semi-lateral position and multi suspension methods. In the abdominal part, gastric separation and lymph node dissection were accomplished with lifting of liver lobe and respective separation of greater curvature and lesser curvature of stomach. The operation time, volume of intraoperative blood loss, time for out-of-bed activities, time of postoperative drainage tube removal, volume of thoracic drainage fluid, postoperative complications, postoperative pathological examination results, time for discharge from hospital and results of follow-up were observed. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis of patients after operation up to February 2019. Count data were described as absolute number. Results The patient underwent successfully closed single-port thoracoscopic and laparoscopic radical esophagectomy and three-field lymph node dissection. The operation time and volume of intraoperative blood loss was 310 minutes and 120 mL. The patient resumed out-of-bed activities at 2 days after operation. The abdominal drainage tube, thoracic closed drainage tube and right cervical drainage tube were removed at 2 days after operation with fasting, acid suppression, nutritional support. The thoracic Abel drainage tube and the left cervical drainage tube were removed at 5 days after operation. The volume of thoracic drainage fluid was 550 mL. No obvious sign of anastomotic leakage was found on esophageal angiography at 5 days after operation. The patient recovered well after operation without hoarseness, pulmonary infection and chylothorax. The postoperative examination result of the patient showed mid-thoracic esophageal squamous cell carcinoma (pT3N1M0G3 ⅢB stage). The patient was discharged at 8 days after operation. The patient was followed up for 3 months, and was able to engage in light physical activity. CT reexamination showed no sign of local recurrence or distant metastasis of the tumor. Conclusion Closed single-port thoracoscopic and laparoscopic radical esopahgectomy for esophageal cancer is safe and feasible, with good short-term efficacy. Key words: Esophageal neoplasms; Esophageal cancer; Radical surgery; Thoracoscopy; Laparoscopy; Single port

Neonatal lymphatic dysplasia is a congenital maldevelopment, causing effusion of chyle or lymph into the limbs or into the pleural, pericardial or peritoneal cavities, forming chylothorax ascites or edema, resulting in immunodeficiency and malnutrition.Neonatal lymphatic dysplasia is rare in neonate, but associated with significant mortality.So far, the etiology and pathological mechanism are still unclear.Lymphoscintigraphy is a diagnostic tool in newborns to obtain early diagnosis.Octreotide has been proposed for treatment of lymphatic dysplasia recently, however, the effiency and safety remain controversial.This article is to review the update in diagnosis and treatment of neonatal lymphatic disorders. Key words: Newborn; Lymphatic dysplasia; Chylothorax

In the conservative treatment of postdiaphragmatic hernia chylothorax, use of octreotide (OCT) had variable results. Limited chyle drainage has not been tried. A newborn, after the left Bochdalek diaphragmatic hernia repair, developed chylothorax. Treatment with intercostal chest tube (ICT) drainage, partial parenteral nutrition (PPN), and medium-chain triglyceride (MCT) with formula feeds was ineffective. ICT slipped out on the 13th day in the presence of significant residual chylothorax. Further drainage was not done. Addition of OCT infusion at maximum dose of 6 μg/kg/h cleared the chylothorax. No side effect of OCT was observed. The present case has proved that MCT feeding along with PPN is effective, and limited drainage of chyle is enough with OCT treatment in postdiaphragmatic hernia chylothorax.

Popliteal Lymphography in a Dog with Chylothorax

Objective To explore the clinical therapeutic effect of thoracoscopy and laparoscopy combined radical operation for esophageal carcinoma and provide reference for clinical treatment. Methods The clinical data of five hundred and twenty-one patients with esophageal cancer in Kunming General Hospital of PLA from June 2010 to May 2017 were analyzed retrospectively. The patients were divided into experimental group (n=276) and control group (n=245) according to the type of procedure. The experimental group was treated with thoracoscopy and laparoscopy, and the control group was treated with open esophagectomy. The intra-operative condition (surgery time, intraoperative blood loss), postoperative condition (postoperative drainage volume, postoperative catheterization time, postoperative hospital stay), postoperative complications (pulmonary infection, anastomotic fistula, recurrent nerve paralysis, chylothorax, gastric emptying delayed, pleural effusion, incisal infection) and life quality [quality of life questionnaire C30 (QLQ-C30) version 3.0 core, quality of life questionnaire- OES18 (QLQ-OES18)] were compared between the two groups. The measurement data were expressed by (±s) and the two group were compared with the t test. The count data were expressed by percentage (%) and inter-group comparisons were performed by chi-square test between the two groups. Results The operation time [(238.7±32.4) min vs (245.1±34.6) min], period of catheter indwelling [(5.7±1.2) d vs (8.7±2.6) d]and hospital stay [(9.6±2.7) d vs (11.4±4.6) d] were shorter, the amount of intraoperative bleeding [(198.6±41.2) ml vs (231.9±43.5) ml] and post-operation drainage [(221.7±32.1) ml vs (257.8±38.6) ml] were less, and the morbidity of lung infection, anastomotic fistula and incision infection were lower in the experimental group than in the control group. The scores of emotional function, physical function and overall health status which belong to QLQ-C30 scale were higher and the scores of difficulty in feeding, reflux, pain, loss of appetite and cough which belong to QLQ-OES18 were lower in the experimental group than in the control group. The differences between the two groups had statistical significance (P<0.05). Conclusion Compared with open esophagectomy, thoracoscopy and laparoscopy combined radical operation for esophageal carcinoma has an advantage in improving the intra-operative and postoperative condition, reducing the postoperative complication rate and enhancing the postoperative life quality. Key words: Esophageal neoplasms; Thoracoscopes; Laparoscopes; Surgical procedures, operative; Clinical efficacy

To explore the impact of the gastric tube diameter on quality of life of esophagus cancer patients after Ivor-Lewis esophagectomy. Clinical and follow-up data of 188 esophageal cancer patients who underwent Ivor-Lewis esophagectomy at Department of Cardio-Thoracic Surgery, Drum Tower Clinical Medicine College, Nanjing Medical University from January 2015 to June 2016 were retrospectively analyzed. Inclusion criteria included age <75 years old, good foundation health situation, no distant metastasis, complete follow-up data for one-year after surgery, and middle-lower esophageal squamous cell carcinoma (ESCC). According to the diameter of gastric tube formed during operation, 92 patients were assigned to narrow gastric tube group (NGT group, ≥2 cm to <4 cm), which were further divided into narrower group (≥2 cm to <3 cm, n=44) and medium narrow group (≥3 cm to <4 cm, n=48); 96 patients were assigned to wide gastric tube group(WGT group, ≥4 cm), which were further divided into medium wide group(≥4 cm to <5 cm, n=50) and wider group(≥5 cm, n=46). Postoperative patients were followed up by telephone or outpatient service for one year and then re-hospitalized to receive associated examinations, including lung function test, esophageal pressure measurement, 24-hour esophageal dynamic pH monitoring (total number of pH<4, number of pH<4 lasting more than 5 minutes, maximum duration of pH<4 and time percentage of pH<4) and dilatation measurement of gastric tube (the diameter measured by CT minus the diameter measured in surgery). During follow-up, postoperative quality of life(QoL) was assessed by questionnaire. These contents were compared and plotted as a chart. There were no statistically significant differences between NGT group and WGT group regard to preoperative baseline information, postoperative pathology and postoperative complications (residual gastric leakage, anastomotic leakage, anastomotic stenosis, pulmonary complications, atrial fibrillation and chylothorax) (all P>0.05). Compared with WGT group, the NGT group had better postoperative lung function, including percentage of vital capacity [(76.4±6.8)% vs. (73.2±7.7)%, t=2.168, P=0.033], percentage of maximal voluntary ventilation [(72.7±6.4)% vs. (69.3±6.8)%, t=2.409, P=0.018] and percentage of forced expiratory volume in the first second [(69.2±5.0)% vs. (66.7±6.2)%, t=2.033, P=0.045], higher plane pressure of anastomotic stoma [(5.4±3.1) mmHg vs. (4.2±2.4) mmHg, t=2.083, P=0.038], greater dilatation of gastric tube [(1.0±0.4) cm vs. (0.5±0.3) cm, t=5.888, P=0.000], milder gastroesophageal reflux according to the indices of 24-hour esophageal dynamic pH monitoring, including the total number of pH<4 (228.3±65.3 vs. 280.8±103.9, t=-2.920,P=0.004), the number of pH<4 lasting more than 5 minutes (19.9±8.5 vs. 30.6±15.6, t=-4.127,P=0.000), the maximum duration of pH<4[(32.5±9.4) minutes vs. (37.9±13.6) minutes, t=-2.232,P=0.028] and the time percentage of pH<4 [(23.4±10.2)% vs. (28.4±10.6)%, t=-2.303, P=0.024]. However, no significant difference was found in the scores of postoperative QoL between the two groups(P=0.051). According to the pairwise comparisons among the four subgroups, narrower group showed better performance on postoperative lung function, plane pressure of anastomotic stoma, the dilatation of gastric tube, indices of 24-hour esophageal dynamic pH monitoring and scores of postoperative QoL as compared to wider group (all P<0.05). There were no statistically significant differences among medium narrow group, medium wide group and wider group. Line charts showed that the larger of the gastric tube diameter, the worse of the postoperative lung function, the more severe of gastroesophageal reflux and the smaller degree of gastric tube dilatation. Narrow gastric tube with a diameter of 2-4 cm can improve the postoperative QoL of esophagus cancer patients after Ivor-Lewis esophagectomy without increasing the risk of postoperative complications.

Two children with chylothorax