Abstract
Chylothorax after esophagectomy typically receives conservative treatment first, but chylothorax can be resistant to such measures and sometimes requires surgical treatment. Depiction of the thoracic duct and identification of the leak point are important when deciding whether surgical intervention is necessary for the therapeutic management of chylothorax. The study included 6 patients with persistent chylothorax after esophagectomy at our institution from 2014 to 2018. These six patients underwent lymphangiography with an inguinal intranodal approach. We retrospectively examined their records and evaluated the efficacy and safety of this technique. Lymphangiography with an inguinal intranodal approach was successful in depicting the thoracic duct in all cases. In addition, identification of the chyle leak was possible in all cases. No complications of this method were observed. Four of the 6 patients showed a marked decrease in chylous effusion within 2 days and were cured by the lymphangiography itself. However, 2 cases required surgical thoracic duct ligation. In the two cases that underwent surgery, the thoracic duct on the cranial side of the leak point was not depicted by lymphangiography, and the thoracic duct itself was leaking. This method is effective not only for identifying the chyle leak point but also for treating chylothorax. Moreover, it helps clarify the indications for surgical thoracic duct ligation. This minimally invasive and safe method may be an option for treatment of chylothorax after esophagectomy.
Similar content being viewed by others
Data Availability
The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author.
References
Abe T, Kawakami J, Uemura N et al (2016) Therapeutic strategy for chylous leakage after esophagectomy: focusing on lymphangiography using lipiodol. Esophagus 13:237–244
Shah RD, Luketich JD, Schuchert MJ (2012) Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg 93:897–903
Cerfolio RJ, Allen MS, Deschamps C et al (1996) Postoperative chylothorax. J Thorac Cardiovasc Surg 112:1361–1366
Miao L, Zhang Y, Hu H et al (2015) Incidence and management of chylothorax after esophagectomy. Thorac Cancer 6(3):354–358
Itkin M, Kucharczuk JC, Kwak A et al (2010) Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients. J Thorac Cardiovasc Surg 139(3):584–589
Hanada K, Hata H, Otani T et al (2016) A case of chylothorax after esophagectomy for esophageal cancer performed thoracoscopic thoracic duct ligation in which lymphangiography by inguinal lymph node puncture was useful. J Jpn Surg Assoc 77(2):322–327
Yamamoto M, Miyata H, Yamasaki M (2015) Chylothorax after esophagectomy cured by intranodal lymphangiography: a case report. Anticancer Res 35:891–896
Rajebi MR, Chaudry G, Padua HM et al (2011) Intranodal lymphangiography: feasibility and preliminary experience in children. J Vasc Interv Radiol 22(9):1300–1305
Nadolski GJ, Itkin M (2012) Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol 23:613–616
Liu J, Sato Y, Motoyama S et al (2016) Ultrasound-guided intranodal lipiodol lymphangiography from the groin is useful for assessment and treatment of post-esophagectomy chylothorax in three cases. Int J Surg Case Rep 29:103–107
Lambertz R, Chang DH, Hickethier T et al (2019) Ultrasound-guided lymphangiography and interventional embolization of chylous leaks following esophagectomy. Innov Surg Sci 4(3):85–90
Satoh Y (2016) Management of chest drainage tubes after lung surgery. Gen Thorac Cardiovasc Surg 64(6):305–308
Kinmonth JB (1954) Lymphangiography in clinical surgery and particularly in the treatment of lymphedema. Ann R Coll Surg Engl 15:300–315
Kortes N, Radeleff B, Sommer CM et al (2014) Therapeutic lymphangiography and CT-guided sclerotherapy for the treatment of refractory lymphatic leakage. J Vasc Interv Radiol 25:127–132
Sato Y, Tanaka Y, Imai T et al (2021) Chylothorax after esophagectomy treated with inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization. Clin J Gastroenterol 14(4):969–974
Nadolski GJ, Itkin M (2012) Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization 23(5):613-6
Lee EW, Shin JH, ko HK et al (2014) Lymphangiography to treat postoperative lymphatic leakage: a technical review. Korean J Radiol 15(6):724–32
Sugimura H, Yamazaki I, Ito Y et al (2016) A case of non-traumatic chylothorax treated by percutaneous transvenous embolization of the thoracic duct. Jpn J Chest Surg 31:122–126
Matsumoto T, Yamagami T, Kato T et al (2009) The effectiveness of lymphangiography as a treatment method for various chyle leakages. Br J Radiol 82:286–290
Kawasaki R, Sugimoto K, Fujii M et al (2013) Therapeutic effectiveness of diagnostic lymphangiography for refractory postoperative chylothorax and chylous ascites: correlation with radiologic findings and preceding medical treatment. Am J Roentgenol 201:659–666
Yoshimatsu R, Yamagami T, Miura H et al (2013) Prediction of therapeutic effectiveness according to CT findings after therapeutic lymphangiography for lymphatic leakage. Jpn J Radiol 31:797–802
Nakashima S, Shiozaki A, Fujiwara H et al (2013) Five cases of chylothorax following esophageal carcinoma resection cured by lipiodol lymphangiography. Jpn J Cancer Chemother 40:2161–2163
Uemura M, Doki Y, Ishikawa O et al (2005) A case of chylothorax after radical surgery for esophageal cancer cured by lipiodol lymphangiography. Jpn J Gastroenterol Surg 38:7–12
Author information
Authors and Affiliations
Contributions
All the authors contributed to the study conception and design. Conceptualization: Seiya Inoue, Takashi Shono; methodology: Seiya Inoue; formal analysis and investigation: Seiya Inoue, Haruka Takasugi, Satoshi Fujiwara; writing — original draft preparation: Seiya Inoue; writing — review and editing: Masakazu Goto, Hiromitsu Takizawa; Supervision: Hiromitsu Takizawa. All the authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethical Statement
All procedures followed were in accordance with the ethical standards of the institutional committee on human experimentation and with the Helsinki Declaration of 1964 and later versions. Informed consent or its substitute was obtained from all patients included in the study.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Inoue, S., Goto, M., Shono, T. et al. Therapeutic Strategy for Chylothorax After Esophagectomy: Lymphangiography with an Inguinal Intranodal Approach. Indian J Surg 85, 1421–1426 (2023). https://doi.org/10.1007/s12262-023-03773-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-023-03773-5