Yidan Lin1, Zhihui Li2, Gang Li3, Xiaolong Zhang3, Hanyu Deng3, Xiaoyan Yang4, Lunxu Liu3. 1. Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China. Electronic address: linyidan@scu.edu.cn. 2. Thyroid and Breast Surgery Department, West China Hospital, Sichuan University, Chengdu, China. 3. Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China. 4. Information Center, West China Hospital, Sichuan University, Chengdu, China.
Abstract
BACKGROUND: Postoperative chylothorax remains an important cause of reoperation and prolonged hospital stay after esophagectomy for the treatment of esophageal carcinoma. Chylothorax is potentially life threatening and difficult to manage. The benefit of routine thoracic duct ligation is controversial. A promising alternative is to identify chyle leaks at the time of esophagectomy and perform the ligation selectively. We developed a novel technique to identify chyle leak at the time of esophagectomy and compared it with routine ligation of thoracic duct. METHODS: This cohort study involved all of the qualified patients with resectable esophageal carcinoma treated between March 1, 2011, and December 31, 2015, by a single surgical team at West China Hospital. Patients receiving routine en masse ligation of the thoracic duct were assigned to group A, and patients receiving selective en masse ligation of the thoracic duct were assigned to group B. All patients in the selective ligation group received 120 mL olive oil orally before the operation. The end point included frequencies of chyle leak detected at the time of esophagectomy, postoperative chylothorax, and need for chylothorax-related reoperation. RESULTS: The study enrolled 296 patients who fulfilled the study requirement: 55 in group A and 241 in group B. Patients in group A experienced significantly higher incidences of postoperative chylothorax and chylothorax-related reoperation than group B (9.1% vs 0% [p < 0.01] and 3.6% vs 0% [p < 0.01]). Incidence of detection of intraoperative chyle leak (chylothorax plus chylous ascites) was significantly higher in group B than in group A (9.5% vs 0%, p < 0.01). No intraoperative or postoperative complications related to preoperative oral olive oil administration or selective en masse ligation of the thoracic duct were observed. CONCLUSIONS: Our method of selective en masse ligation of the thoracic duct during esophagectomy was feasible and safe and was associated with reduced rates of postoperative chylothorax.
BACKGROUND: Postoperative chylothorax remains an important cause of reoperation and prolonged hospital stay after esophagectomy for the treatment of esophageal carcinoma. Chylothorax is potentially life threatening and difficult to manage. The benefit of routine thoracic duct ligation is controversial. A promising alternative is to identify chyle leaks at the time of esophagectomy and perform the ligation selectively. We developed a novel technique to identify chyle leak at the time of esophagectomy and compared it with routine ligation of thoracic duct. METHODS: This cohort study involved all of the qualified patients with resectable esophageal carcinoma treated between March 1, 2011, and December 31, 2015, by a single surgical team at West China Hospital. Patients receiving routine en masse ligation of the thoracic duct were assigned to group A, and patients receiving selective en masse ligation of the thoracic duct were assigned to group B. All patients in the selective ligation group received 120 mL olive oil orally before the operation. The end point included frequencies of chyle leak detected at the time of esophagectomy, postoperative chylothorax, and need for chylothorax-related reoperation. RESULTS: The study enrolled 296 patients who fulfilled the study requirement: 55 in group A and 241 in group B. Patients in group A experienced significantly higher incidences of postoperative chylothorax and chylothorax-related reoperation than group B (9.1% vs 0% [p < 0.01] and 3.6% vs 0% [p < 0.01]). Incidence of detection of intraoperative chyle leak (chylothorax plus chylous ascites) was significantly higher in group B than in group A (9.5% vs 0%, p < 0.01). No intraoperative or postoperative complications related to preoperative oral olive oil administration or selective en masse ligation of the thoracic duct were observed. CONCLUSIONS: Our method of selective en masse ligation of the thoracic duct during esophagectomy was feasible and safe and was associated with reduced rates of postoperative chylothorax.
Authors: Sivesh K Kamarajah; Manjunath Siddaiah-Subramanya; Alessandro Parente; Richard P T Evans; Ademola Adeyeye; Alan Ainsworth; Alberto M L Takahashi; Alex Charalabopoulos; Andrew Chang; Atila Eroglue; Bas Wijnhoven; Claire Donohoe; Daniela Molena; Eider Talavera-Urquijo; Flavio Roberto Takeda; Gail Darling; German Rosero; Guillaume Piessen; Hans Mahendran; Hsu Po Kuei; Ines Gockel; Ionut Negoi; Jacopo Weindelmayer; Jari Rasanen; Kebebe Bekele; Guowei Kim; Lieven Depypere; Lorenzo Ferri; Magnus Nilsson; Frederik Klevebro; B Mark Smithers; Mark I van Berge Henegouwen; Peter Grimminger; Paul M Schneider; C S Pramesh; Raza Sayyed; Richard Babor; Shinji Mine; Simon Law; Suzanne Gisbertz; Tim Bright; Xavier Benoit D'Journo; Donald Low; Pritam Singh; Ewen A Griffiths Journal: Ann Surg Open Date: 2022-08-29