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J Am Coll Surg. 2014 Jan;218(1):108-12. doi: 10.1016/j.jamcollsurg.2013.09.014. Epub 2013 Nov 7.

A simple method minimizes chylothorax after minimally invasive esophagectomy.

Author information

1
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
2
University College Hospital, London, United Kingdom.
3
Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: Tan.lijie@zs-hospital.sh.cn.

Abstract

BACKGROUND:

Postoperative chylothorax is a rare, but potentially fatal complication after esophagectomy. Preventive measures aimed at decreasing the incidence of chyle leakage after minimally invasive esophagectomy (MIE) could potentially reduce the high postoperative mortality associated with this complication. However, previous techniques are traumatic and time consuming. We present a simple method in the prophylaxis of chylothorax after MIE.

STUDY DESIGN:

A total of 344 consecutive esophageal cancer patients who underwent 3-stage MIE between June 2006 and July 2012 were included. Of these, 178 patients were given preoperative milk orally 6 hours before surgery (Group M+), and 166 underwent MIE without preoperative milk and served as controls (Group M-). Patient demographics were retrospectively collected. The incidences of intraoperative thoracic duct identification and postoperative chylothorax were recorded and statistically compared between the 2 groups.

RESULTS:

In this cohort, the 2 groups were comparable in clinical features including age, sex, tumor location, histologic type, and TNM stage. No patient was converted to open thoracotomy. During the thoracoscopic stage, a higher incidence of duct identification (95.5% vs 12.7%, p < 0.001) and a lower incidence of duct ligation (6.74% vs 13.25%, p = 0.039) were recorded in Group M+. Postoperatively, a total of 10 cases of chylothorax (2.91%) were observed. The incidence of chylothorax was significantly lower in Group M+ than in Group M- (0.56% vs 5.42%, p = 0.018).

CONCLUSIONS:

Preoperative oral administration of milk facilitates visualization of the thoracic duct and minimizes the risk of iatrogenic injury to the thoracic duct during thoracoscopic esophagectomy. It is a simple and safe method for preventing chyle leakage after MIE. A randomized and controlled trial is required to confirm these findings.

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