Journal of Shanghai Jiao Tong University (Medical Science) >
Research progress in diagnosis and treatment of chylothorax after esophagectomy
Received date: 2022-05-20
Accepted date: 2022-10-27
Online published: 2023-02-28
Supported by
National Natural Science Foundation of China(8207100395)
Thoracic duct is the longest lymphatic duct in the human body and plays an important role in maintaining normal metabolism and immune function. Chylothorax is a rare complication after esophageal surgery, which is caused by the injury of the thoracic duct during esophagectomy, resulting in the accumulation of chyle in the pleural cavity. The etiology may be related to anatomical variation, patient's general condition, tumor stage, perioperative intervention and other factors. Preoperative and intraoperative preventive measures can reduce the incidence of chylothorax. Although the incidence rate is low, misdiagnosis or unsuccessful management can increase postoperative complications and lead to serious metabolic disorders and even death. Therefore, early diagnosis and intervention are of paramount importance. Diagnosis should be based on clinical manifestations, supplemented by laboratory and imaging studies. Currently, there is no standard for treatment, which mainly includes conservative treatment, interventional treatment, and surgical treatment. It is necessary to make a comprehensive judgment according to the actual situation and select the appropriate treatment method. In recent years, interventional technology could accurately localize the chylothorax, which is expected to play a more important role in the treatment of chylothorax. This article reviews the latest advances in the etiology, diagnosis, treatment, and prevention of chylothorax after esophagectomy and provides a flow chart of treatment steps to effectively manage this complication.
Key words: esophageal cancer; chylothorax; thoracic duct
Xinyu WANG , Xiaojing ZHAO , Jian TANG . Research progress in diagnosis and treatment of chylothorax after esophagectomy[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023 , 43(2) : 244 -249 . DOI: 10.3969/j.issn.1674-8115.2023.02.015
1 | FEI X, WANG X Y, LU Q J, et al. The influence of thoracic duct ligation on long-term survival of patients with esophageal cancer: a propensity score-matched analysis[J]. J Thorac Dis, 2020, 12(10): 5532-5541. |
2 | CHEN K N. Managing complications I: leaks, strictures, emptying, reflux, chylothorax[J]. J Thorac Dis, 2014, 6(Suppl 3): S355-S363. |
3 | PHANG K, BOWMAN M, PHILLIPS A, et al. Review of thoracic duct anatomical variations and clinical implications[J]. Clin Anat, 2014, 27(4): 637-644. |
4 | JOHNSON O W, CHICK J F, CHAUHAN N R, et al. The thoracic duct: clinical importance, anatomic variation, imaging, and embolization[J]. Eur Radiol, 2016, 26(8): 2482-2493. |
5 | MIRANDA GARCéS M, MIRAPEIX R, PONS G, et al. A comprehensive review of the natural lymphaticovenous communications and their role in lymphedema surgery[J]. J Surg Oncol, 2016, 113(4): 374-380. |
6 | CHEN S F, ZHAO Y, CHEN H Q. Risk factors of chylothorax after esophagectomy[J]. J Thorac Dis, 2019, 11(5): 1749-1752. |
7 | OHKURA Y, UENO M, SHINDOH J, et al. Risk factors for postoperative chylothorax after radical subtotal esophagectomy[J]. Ann Surg Oncol, 2018, 25(9): 2739-2746. |
8 | GRONNIER C, TRéCHOT B, DUHAMEL A, et al. Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a European multicenter study[J]. Ann Surg, 2014, 260(5): 764-770; discussion 770-771. |
9 | YANG H, LIU H, CHEN Y P, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): a phase Ⅲ multicenter, randomized, open-label clinical trial[J]. J Clin Oncol, 2018, 36(27): 2796-2803. |
10 | ZHANG S S, YANG H, LUO K J, et al. The impact of body mass index on complication and survival in resected oesophageal cancer: a clinical-based cohort and meta-analysis[J]. Br J Cancer, 2013, 109(11): 2894-2903. |
11 | MIAO L S, ZHANG Y W, HU H, et al. Incidence and management of chylothorax after esophagectomy[J]. Thorac Cancer, 2015, 6(3): 354-358. |
12 | CHENG C, WEN Y W, TSAI C Y, et al. Impact of Child-Pugh class A liver cirrhosis on perioperative outcomes of patients with oesophageal cancer: a propensity score-matched analysis[J]. Eur J Cardiothorac Surg, 2020: ezaa334. |
13 | MALIBARY N, MANFREDELLI S, ALMUTTAWA A, et al. Evaluating the surgeon's experience as a risk factor for post-esophagectomy chylothorax on a four-year cohort[J]. Cureus, 2020, 12(6): e8696. |
14 | MATSUTANI T, HIRAKATA A, NOMURA T, et al. Transabdominal approach for chylorrhea after esophagectomy by using fluorescence navigation with indocyanine green[J]. Case Rep Surg, 2014, 2014: 464017. |
15 | 牛玲莉, 邱丽, 阳茂丹, 等. 胸腔积液乳糜定性试验在胸外科术后的诊断价值与影响因素[J]. 中国胸心血管外科临床杂志, 2021, 28(9): 1037-1043. |
15 | NIU L L, QIU L, YANG M D, et al. Diagnostic value and influencing factors of chylous test of pleural effusion after thoracic surgery[J]. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9): 1037-1043. |
16 | VARSHNEY V K, SUMAN S, GARG P K, et al. Management options for post-esophagectomy chylothorax[J]. Surg Today, 2021, 51(5): 678-685. |
17 | HYUN D, LEE H Y, CHO J H, et al. Pragmatic role of noncontrast magnetic resonance lymphangiography in postoperative chylothorax or cervical chylous leakage as a diagnostic and preprocedural planning tool[J]. Eur Radiol, 2022, 32(4): 2149-2157. |
18 | LOW D E, ALDERSON D, CECCONELLO I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG)[J]. Ann Surg, 2015, 262(2): 286-294. |
19 | MISTHOS P, KANAKIS M A, LIOULIAS A G. Chylothorax complicating thoracic surgery: conservative or early surgical management?[J]. Updates Surg, 2012, 64(1): 5-11. |
20 | ISMAIL N A, GORDON J, DUNNING J. The use of octreotide in the treatment of chylothorax following cardiothoracic surgery[J]. Interact Cardiovasc Thorac Surg, 2015, 20(6): 848-854. |
21 | POWER R, SMYTH P, DONLON N E, et al. Management of chyle leaks following esophageal resection: a systematic review[J]. Dis Esophagus, 2021, 34(11): doab012. |
22 | OHKURA Y, UENO M, IIZUKA T, et al. Effectiveness of etilefrine regimen for chylothorax after esophagectomy with thoracic duct resection[J]. Esophagus, 2018, 15(1): 33-38. |
23 | BENDER B, MURTHY V, CHAMBERLAIN R S. The changing management of chylothorax in the modern era[J]. Eur J Cardiothorac Surg, 2016, 49(1): 18-24. |
24 | TASHNIZI M A, MALEKI M H, JAVEDANFAR O, et al. Platelet-rich plasma fibrin glue for treatment of chylothorax following cavopulmonary connections[J]. Eur J Cardiothorac Surg, 2020, 58(6): 1269-1273. |
25 | ALAMDARI D H, ASADI M, RAHIM A N, et al. Efficacy and safety of pleurodesis using platelet-rich plasma and fibrin glue in management of postoperative chylothorax after esophagectomy[J]. World J Surg, 2018, 42(4): 1046-1055. |
26 | COPE C. Diagnosis and treatment of postoperative chyle leakage via percutaneous transabdominal catheterization of the cisterna chyli: a preliminary study[J]. J Vasc Interv Radiol, 1998, 9(5): 727-734. |
27 | CHEN C S, KIM J W, SHIN J H, et al. Lymphatic imaging and intervention for chylothorax following thoracic aortic surgery[J]. Medicine (Baltimore), 2020, 99(34): e21725. |
28 | ITKIN M, KUCHARCZUK J C, KWAK A, et al. Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients[J]. J Thorac Cardiovasc Surg, 2010, 139(3): 584-589;discussion 589-590. |
29 | KIM P H, TSAUO J, SHIN J H. Lymphatic interventions for chylothorax: a systematic review and meta-analysis[J]. J Vasc Interv Radiol, 2018, 29(2): 194-202.e4. |
30 | MARTHALLER K J, JOHNSON S P, PRIDE R M, et al. Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration[J]. Am J Surg, 2015, 209(2): 235-239. |
31 | JEON Y J, CHO J H, HYUN D, et al. Management of chyle leakage after general thoracic surgery: impact of thoracic duct embolization[J]. Thorac Cancer, 2021, 12(9): 1382-1386. |
32 | NOVELLI P M, CHAN E G, FRAZIER A A, et al. Interventional therapies for thoracic duct injury and intractable chylothorax[J]. J Thorac Imaging, 2019, 34(4): 258-265. |
33 | MISHRA P K, SALUJA S S, RAMASWAMY D, et al. Thoracic duct injury following esophagectomy in carcinoma of the esophagus: ligation by the abdominal approach[J]. World J Surg, 2013, 37(1): 141-146. |
34 | TANG H X, BAI Y Q, SHEN W L, et al. Anastomosis of the thoracic duct and the azygos vein for the treatment of recurrent chylothoraxes[J]. Eur J Cardiothorac Surg, 2018, 53(5): 1093-1094. |
35 | YUAN Y, CHEN L Q, ZHAO Y F. Anastomosis between thoracic duct and azygos vein during esophagectomy: a novel technique with 3-year follow-up[J]. World J Surg, 2016, 40(12): 2984-2987. |
36 | YANG Y H, PARK S Y, KIM D J. Chyle leakage after esophageal cancer surgery[J]. Korean J Thorac Cardiovasc Surg, 2020, 53(4): 191-199. |
37 | SHEN Y X, FENG M X, KHAN M A, et al. A simple method minimizes chylothorax after minimally invasive esophagectomy[J]. J Am Coll Surg, 2014, 218(1): 108-112. |
38 | DU Z S, LI X Y, LUO H S, et al. Preoperative administration of olive oil reduces chylothorax after minimally invasive esophagectomy[J]. Ann Thorac Surg, 2019, 107(5): 1540-1543. |
39 | VECCHIATO M, MARTINO A, SPONZA M, et al. Thoracic duct identification with indocyanine green fluorescence during minimally invasive esophagectomy with patient in prone position[J]. Dis Esophagus, 2020, 33(12): doaa030. |
40 | CRUCITTI P, MANGIAMELI G, PETITTI T, et al. Does prophylactic ligation of the thoracic duct reduce chylothorax rates in patients undergoing oesophagectomy? A systematic review and meta-analysis[J]. Eur J Cardiothorac Surg, 2016, 50(6): 1019-1024. |
41 | GUO W, ZHAO Y P, JIANG Y G, et al. Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer[J]. Surg Endosc, 2012, 26(5): 1332-1336. |
42 | CHEN J Y, LIU Q W, ZHANG S S, et al. Prophylactic thoracic duct ligation is associated with poor prognosis and regional lymph node relapse in esophageal squamous cell carcinoma[J]. J Surg Oncol, 2020, 122(2): 336-343. |
43 | BéDAT B, SCARPA C R, SADOWSKI S M, et al. Acute pancreatitis after thoracic duct ligation for iatrogenic chylothorax. A case report[J]. BMC Surg, 2017, 17(1): 9. |
44 | LIN Y D, LI Z H, LI G, et al. Selective en masse ligation of the thoracic duct to prevent chyle leak after esophagectomy[J]. Ann Thorac Surg, 2017, 103(6): 1802-1807. |
45 | BROWN S, ABANA C O, HAMMAD H, et al. Low-dose radiation therapy is an effective treatment for refractory postoperative chylous ascites: a case report[J]. Pract Radiat Oncol, 2019, 9(3): 153-157. |
/
〈 |
|
〉 |