H H de Gier1, A J Balm, P F Bruning, R T Gregor, F J Hilgers. 1. Department of Otolaryngology/Head & Neck surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek Hospital), Amsterdam, The Netherlands.
Abstract
BACKGROUND: Chylous leakage is an uncommon complication after neck dissection for which several treatment modalities have been described in literature. It occurs in 1% to 2.5% of radical neck dissections, with the majority (75% to 92%) being on the left side. In a consecutive series of patients, we investigated the effect of a systematic approach to the complication. METHODS: Over a period of 5 years, the drain production of 221 patients who underwent a neck dissection was analyzed. One hundred thirty-two right-sided and 139 left-sided neck dissections were performed. In 11 patients a chyle fistula occurred, 1 right-sided and 10 lift-sided. In all cases closed vacuum suction drainage was continued and dietary modifications (medium-chain triglycerides [MCT]/Peptison nasogastric tube feeding [PNTF]) were made. RESULTS: In 5 patients dietary modifications were sufficient to stop the leak. In the other 6 patients total parenteral nutrition via the subclavian vein (TPN) was started. In 2 cases with a severe intractable hypoalbuminemia, surgical intervention was necessary. The leak was closed by a pectoralis major muscle flap transfer, after local application of fibrin sealant (Tissucol). CONCLUSIONS: Chylous leakage is a controllable complication after neck dissection for which is most cases a stepwise conservative approach consisting of dietary modifications, maintaining closed vacuum suction drainage, seems to be sufficient. Hematologic and serum values should be monitored very carefully and corrected appropriately. To initiate planned postoperative radiotherapy in a timely fashion, the conservative treatment should be limited to about 30 days.
BACKGROUND: Chylous leakage is an uncommon complication after neck dissection for which several treatment modalities have been described in literature. It occurs in 1% to 2.5% of radical neck dissections, with the majority (75% to 92%) being on the left side. In a consecutive series of patients, we investigated the effect of a systematic approach to the complication. METHODS: Over a period of 5 years, the drain production of 221 patients who underwent a neck dissection was analyzed. One hundred thirty-two right-sided and 139 left-sided neck dissections were performed. In 11 patients a chyle fistula occurred, 1 right-sided and 10 lift-sided. In all cases closed vacuum suction drainage was continued and dietary modifications (medium-chain triglycerides [MCT]/Peptison nasogastric tube feeding [PNTF]) were made. RESULTS: In 5 patients dietary modifications were sufficient to stop the leak. In the other 6 patients total parenteral nutrition via the subclavian vein (TPN) was started. In 2 cases with a severe intractable hypoalbuminemia, surgical intervention was necessary. The leak was closed by a pectoralis major muscle flap transfer, after local application of fibrin sealant (Tissucol). CONCLUSIONS: Chylous leakage is a controllable complication after neck dissection for which is most cases a stepwise conservative approach consisting of dietary modifications, maintaining closed vacuum suction drainage, seems to be sufficient. Hematologic and serum values should be monitored very carefully and corrected appropriately. To initiate planned postoperative radiotherapy in a timely fashion, the conservative treatment should be limited to about 30 days.
Authors: Ali Harlak; Serdar Karahatay; Onder Onguru; Oner Mentes; Mustafa Gerek; Turgut Tufan Journal: Breast Care (Basel) Date: 2008-08-11 Impact factor: 2.860
Authors: Rajesh Singh; Sharath Krishnan; Nebu Abraham George; Balagopal Prabhakar Gowri; M Iqbal Ahamed; Paul Sebastian Journal: Indian J Surg Oncol Date: 2015-08-20
Authors: Jeffery Chakedis; Lawrence A Shirley; Alicia M Terando; Roman Skoracki; John E Phay Journal: Ann Surg Oncol Date: 2018-08-03 Impact factor: 5.344
Authors: Yong Sang Lee; Kee-Hyun Nam; Woong Youn Chung; Hang-Seok Chang; Cheong Soo Park Journal: J Korean Med Sci Date: 2010-03-19 Impact factor: 2.153