Outcome of a Step-Up Treatment Strategy for Chyle Leakage After Esophagectomy

The Annals of Thoracic Surgery
Teun J WeijsRichard van Hillegersberg

Abstract

Thoracic chyle leakage is a major complication of esophagectomy. In this study our treatment strategy for chyle leakage was evaluated and its risk factors were identified. According to the Esophagectomy Complications Consensus Group recommendations, chyle leakage was classified as follows: I, enteric dietary modifications; II, total parenteral nutrition (TPN); and III, interventional or surgical therapy. It was graded as A, less than 1,000 mL per day; or B, more than 1,000 mL per day. In our protocol, chyle leakage less than 500 mL per day was treated with a low-fat diet; more than 1,000 mL per day, with TPN, and 500 to 1,000 mL per day, with a low-fat diet or TPN depending on whether the chyle leakage was increasing or decreasing at diagnosis and the clinical condition. Surgery was reserved for refractory leakages. In total 371 patients were included. Chyle leakage incidence was 21%, consisting of 51% grade A and 49% grade B leakage. Chyle leakage severity was associated with length of stay (grade A, median 17 days versus B, 25 days; p = 0.006). Independent risk factors were a transthoracic approach (odds ratio 4.8, p = 0.002), neoadjuvant chemoradiotherapy (odds ratio 2.6, p = 0.002), and preoperative body mass index (exp(B) ...Continue Reading

Citations

Aug 15, 2020·The Korean Journal of Thoracic and Cardiovascular Surgery·Young Ho YangDae Joon Kim
Mar 17, 2021·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·Robert PowerJohn V Reynolds

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