Pamela Milito1,2, Jakub Chmelo1, Lorna Dunn1,3, Sivesh K Kamarajah1, Anantha Madhavan1, Shajahan Wahed1, Arul Immanuel1, S Michael Griffin1, Alexander W Phillips4,5. 1. Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK. 2. University of Milan, Milan, Italy. 3. Northumbria Healthcare NHS Foundation Trust, Northumbria, UK. 4. Northern Oesophago-Gastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK. awphillips@doctors.net.uk. 5. School of Medical Education, Newcastle University, Newcastle upon Tyne, UK. awphillips@doctors.net.uk.
Abstract
BACKGROUND: Chyle leak is an uncommon complication following esophagectomy, accounting for significant morbidity and mortality; however, the optimal treatment for the chylothorax is still controversial. OBJECTIVE: The aim of this study was to evaluate the incidence, management, and outcomes of chyle leaks within a specialist esophagogastric cancer center. METHODS: Consecutive patients undergoing esophagectomy for esophageal cancers (adenocarcinoma or squamous cell carcinoma) between 1997 and 2017 at the Northern Oesophagogastric Unit were included from a contemporaneously maintained database. Primary outcome was overall survival, while secondary outcomes were overall complications, anastomotic leaks, and pulmonary complications. RESULTS: During the study period, 992 patients underwent esophagectomy for esophageal cancers, and 5% (n = 50) of them developed chyle leaks. There was no significant difference in survival in patients who developed a chyle leak compared with those who did not (median: 40 vs. 45 months; p = 0.60). Patients developing chyle leaks had a significantly longer length of stay in critical care (median: 4 vs. 2 days; p = 0.002), but no difference in total length of hospital stay. CONCLUSION: Chyle leak remains a complication following esophagectomy, with limited understanding on its pathophysiology in postoperative recovery. However, these data indicate chyle leak does not have a long-term impact on patients and does not affect long-term survival.
BACKGROUND: Chyle leak is an uncommon complication following esophagectomy, accounting for significant morbidity and mortality; however, the optimal treatment for the chylothorax is still controversial. OBJECTIVE: The aim of this study was to evaluate the incidence, management, and outcomes of chyle leaks within a specialist esophagogastric cancer center. METHODS: Consecutive patients undergoing esophagectomy for esophageal cancers (adenocarcinoma or squamous cell carcinoma) between 1997 and 2017 at the Northern Oesophagogastric Unit were included from a contemporaneously maintained database. Primary outcome was overall survival, while secondary outcomes were overall complications, anastomotic leaks, and pulmonary complications. RESULTS: During the study period, 992 patients underwent esophagectomy for esophageal cancers, and 5% (n = 50) of them developed chyle leaks. There was no significant difference in survival in patients who developed a chyle leak compared with those who did not (median: 40 vs. 45 months; p = 0.60). Patients developing chyle leaks had a significantly longer length of stay in critical care (median: 4 vs. 2 days; p = 0.002), but no difference in total length of hospital stay. CONCLUSION: Chyle leak remains a complication following esophagectomy, with limited understanding on its pathophysiology in postoperative recovery. However, these data indicate chyle leak does not have a long-term impact on patients and does not affect long-term survival.
Authors: Joel Shapiro; J Jan B van Lanschot; Maarten C C M Hulshof; Pieter van Hagen; Mark I van Berge Henegouwen; Bas P L Wijnhoven; Hanneke W M van Laarhoven; Grard A P Nieuwenhuijzen; Geke A P Hospers; Johannes J Bonenkamp; Miguel A Cuesta; Reinoud J B Blaisse; Olivier R C Busch; Fiebo J W Ten Kate; Geert-Jan M Creemers; Cornelis J A Punt; John Th M Plukker; Henk M W Verheul; Ernst J Spillenaar Bilgen; Herman van Dekken; Maurice J C van der Sangen; Tom Rozema; Katharina Biermann; Jannet C Beukema; Anna H M Piet; Caroline M van Rij; Janny G Reinders; Hugo W Tilanus; Ewout W Steyerberg; Ate van der Gaast Journal: Lancet Oncol Date: 2015-08-05 Impact factor: 41.316
Authors: Sivesh K Kamarajah; Anantha Madhavan; Jakub Chmelo; Maziar Navidi; Shajahan Wahed; Arul Immanuel; Nick Hayes; S Michael Griffin; Alexander W Phillips Journal: Ann Surg Oncol Date: 2021-03-03 Impact factor: 5.344
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
Authors: Robert Power; Philip Smyth; Noel E Donlon; Timothy Nugent; Claire L Donohoe; John V Reynolds Journal: Dis Esophagus Date: 2021-11-11 Impact factor: 3.429