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Role of Octreotide in Conservative Management of Chyle Leak Post Neck Dissection in Cases of Head Neck Cancer: A Retrospective Analysis

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Abstract

Chyle leak is a dreadful complication in patients undergoing neck dissections. Octreotide has been used in the management of chyle leak post neck dissections in head and neck cancer patients. Currently there is no consensus and practice guidelines on the same. (1) To study the role of octreotide in early cessation of post neck dissection chyle leak. (2) To study incidence of intra-operative and post-operative CL, its relation to the extent of nodal disease and neck dissection, prior radiotherapy. Retrospective analysis of 16 patients out of 529 neck dissection over a period of 03 years between Jan 2016 and Dec 2019 who developed post-operative chyle leak. All patients who had post-operative chyle leak were administered octreotide. Time taken for chyle leak to stop was primary outcome. Secondary outcomes were duration of hospitalization post-operatively, incidence of intra-operative and post-operative chyle leak, its relation to the extent of nodal disease, prior radiotherapy and type of neck dissection. 59 of 529 neck dissections (11.15%) were noted to have intra-operative chyle leak. 16 of 529 neck dissections (3.02%) developed post-operative chyle leak. On applying chi square test, prior multimodality and N plus neck were found to be significant risk factors in developing postoperative chyle leak. Considering only RT versus no RT in prior multimodality treated group, the difference was insignificant. Onset of chyle leak varied from 1 to 5 post-op day (mean 2.68 days). 15 (93.75%) patients responded to octreotide. Chyle leak resolved between 3 and 10 days (mean 5.18 days) and octreotide was given for 5–12 days (mean-7.18 days). Overall duration of hospitalization ranged from 09 to 18 days (mean 12.18 days). 01 patient (6.25%) had to be re-explored due to high volume leak despite using octreotide. Adverse effects of octreotide were minimal and tolerable. Octreotide is effective in reducing the duration of chyle leak, hospital stay and need for surgical intervention. It may be considered as suitable adjunct to conservative measures in the management for post-operative chyle leak.

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References

  1. D’Cruz AK, Vaish R, Kapre N et al (2015) Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 373(6):521–529

    Article  Google Scholar 

  2. Delaney SW, Shi H, Shokrani A, Sinha UK (2017) Management of chyle leak after head and neck surgery: review of current treatment strategies. Int J Otolaryngol 2017:1–12

    Article  Google Scholar 

  3. Aires FT, Vanderlei FA, Moyses RA, Cernea CR, Tavares MR (2018) High-output chyle fistula treated with octreotide after neck dissection for papillary thyroid carcinoma. Arch Head Neck Surg 47(1):1–6

    Article  Google Scholar 

  4. Roh JL, Kim DH, Park CI (2008) Prospective identification of chyle leakage in patients undergoing lateral neck dissection for metastatic thyroid cancer. Ann Surg Oncol 15(2):424–429

    Article  Google Scholar 

  5. Park I, Her N, Choe JH, Kim JS, Kim JH (2018) Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer. Head Neck 40(1):7–15

    Article  Google Scholar 

  6. Lee YS, Nam KH, Chung WY, Chang HS, Park CS (2010) Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci 25(4):541–545

    Article  Google Scholar 

  7. McCray S, Parrish CR (2004) When chyle leaks: nutrition management options. Pract Gastroenterol 28(5):60

  8. Jain A, Singh SN, Singhal P, Sharma MP, Grover M (2015) A prospective study on the role of octreotide in management of chyle fistula neck. Laryngoscope 125(7):1624–1627

    Article  CAS  Google Scholar 

  9. Chan JY, Wong EW, Ng SK, van Hasselt CA, Vlantis AC (2017) Conservative management of postoperative chylous fistula with octreotide and peripheral total parenteral nutrition. Ear Nose Throat J 96(7):264–267

    Article  Google Scholar 

  10. Swanson MS, Hudson RL, Bhandari N, Sinha UK, Maceri DR, Kokot N (2015) Use of octreotide for the management of chyle fistula following neck dissection. JAMA Otolaryngol Head Neck Surg 141(8):723–727

    Article  Google Scholar 

  11. Ahn D, Jeon JH, Kim H, Sohn JH (2016) Effect of octreotide injection on postoperative drainage after neck dissection: a preliminary report of a prospective, matched case-control study. Clin Exp Otorhinolaryngol 9(2):173

    Article  CAS  Google Scholar 

  12. Gregor RT (2000) Management of chyle fistulization in association with neck dissection. Otolaryngol Head Neck Surg. 122(3):434–439

    Article  CAS  Google Scholar 

  13. Ammar K, Tubbs RS, Smyth MD et al (2003) Anatomic landmarks for the cervical portion of the thoracic duct. Neurosurgery 53(6):1385–1388

    Article  Google Scholar 

  14. Nussenbaum B, Liu JH, Sinard RJ (2000) Systematic management of chyle fistula: the Southwestern experience and review of the literature. Otolaryngol Head Neck Surg 122(1):31–38

    Article  CAS  Google Scholar 

  15. Phang K, Bowman M, Phillips A, Windsor J (2014) Review of thoracic duct anatomical variations and clinical implications. Clin Anat 27(4):637–644

    Article  CAS  Google Scholar 

  16. Kinnaert P (1973) Anatomical variations of the cervical portion of the thoracic duct in man. J Anat 115(Pt 1):45

    CAS  Google Scholar 

  17. de Gier HH, Balm AJ, Bruning PF, Gregor RT, Hilgers FJ (1996) Systematic approach to the treatment of chylous leakage after neck dissection. Head Neck J Sci Spec Head Neck 18(4):347–351

    Article  Google Scholar 

  18. Merki V, Pichler J, Giger R, Mantokoudis G (2016) Chylothorax in thyroid surgery: a very rare case and systematic review of the literature. J Otolaryngol Head Neck Surg 45(1):52

    Article  Google Scholar 

  19. Ilczyszyn A, Ridha H, Durrani AJ (2011) Management of chyle leak post neck dissection: a case report and literature review. J Plast Reconstr Aesthet Surg 64(9):e223-230

    Article  Google Scholar 

  20. Scorza LB, Goldstein BJ, Mahraj RP (2008) Modern management of chylous leak following head and neck surgery: a discussion of percutaneous lymphangiography-guided cannulation and embolization of the thoracic duct. Otolaryngol Clin N Am 41(6):1231–1240

    Article  Google Scholar 

  21. Crumley RL, Smith JD (1976) Postoperative chylous fistula prevention and management. Laryngoscope 86(6):805–813

    Article  Google Scholar 

  22. Cernea CR, Hojaij FC, De Carlucci JD et al (2012) Abdominal compression: a new intraoperative maneuver to detect chyle fistulas during left neck dissections that include level IV. Head Neck 34(11):1570–1573

    Article  Google Scholar 

  23. Qureshi SS, Chaturvedi P (2007) A novel technique of management of high output chyle leak after neck dissection. J Surg Oncol 96(2):176–177

    Article  Google Scholar 

  24. Rodgers GK, Johnson JT, Petruzzelli GJ, Warty VS, Wagner RL (1992) Lipid and volume analysis of neck drainage in patients undergoing neck dissection. Am J Otolaryngol 13(5):306–309

    Article  CAS  Google Scholar 

  25. Rimensberger PC, Müller-Schenker B, Kalangos A, Beghetti M (1998) Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg 66(1):253–254

    Article  CAS  Google Scholar 

  26. Kalomenidis I (2006) Octreotide and chylothorax. Curr Opin Pulm Med 12(4):264–267

    Article  Google Scholar 

  27. Gómez-Caro AA, Diez MF, Marrón CF, Cabrero LE, de Nicolás MJ (2005) Conservative management of postsurgical chylothorax with octreotide. Asian Cardiovasc Thorac Ann 13(3):222–224

    Article  Google Scholar 

  28. Barili F, Polvani G, Topkara VK et al (2007) Administration of octreotide for management of postoperative high-flow chylothorax. Ann Vasc Surg 21(1):90–92

    Article  Google Scholar 

  29. Nakabayashi H, Sagara H, Usukura N et al (1981) Effect of somatostatin on the flow rate and triglyceride levels of thoracic duct lymph in normal and vagotomized dogs. Diabetes 30(5):440–445

    Article  CAS  Google Scholar 

  30. Nyquist GG, Hagr A, Sobol SE, Hier MP, Black MJ (2003) Octreotide in the medical management of chyle fistula. Otolaryngol Head Neck Surg 128(6):910–911

    Article  Google Scholar 

  31. Ahn D, Sohn JH, Jeong JY (2015) Chyle fistula after neck dissection: an 8-year, single-center, prospective study of incidence, clinical features, and treatment. Ann Surg Oncol 22(3):1000–1006

    Article  Google Scholar 

  32. Coşkun A, Yildirim M (2010) Somatostatin in medical management of chyle fistula after neck dissection for papillary thyroid carcinoma. Am J Otolaryngol 31(5):395–396

    Article  Google Scholar 

  33. Kadota H, Kakiuchi Y, Yoshida T (2012) Management of chylous fistula after neck dissection using negative-pressure wound therapy: a preliminary report. Laryngoscope 122(5):997–999

    Article  Google Scholar 

  34. Orgill DP, Bayer LR (2011) Update on negative-pressure wound therapy. Plast Reconstr Surg 127:105S-S115

    Article  CAS  Google Scholar 

  35. Brennan PA, Blythe JN, Herd MK, Habib A, Anand R (2012) The contemporary management of chyle leak following cervical thoracic duct damage. Br J Oral Maxillofac Surg 50(3):197–201

    Article  CAS  Google Scholar 

  36. Light RW (1990) Chylothorax and pseudochylothorax. Pleural Dis 269–281

  37. Kassel RN, Havas TE, Gullane PJ (1987) The use of topical tetracycline in the management of persistent chylous fistulae. J Otolaryngol 16(3):174–178

    CAS  Google Scholar 

  38. Campisi CC, Boccardo F, Piazza C, Campisi C (2013) Evolution of chylous fistula management after neck dissection. Curr Opin Otolaryngol Head Neck Surg 21(2):150–156

    Article  Google Scholar 

  39. Gunnlaugsson CB, Iannettoni MD, Yu B, Chepeha DB, Teknos TN (2004) Management of chyle fistula utilizing thoracoscopic ligation of the thoracic duct. ORL 66(3):148–154

    Article  Google Scholar 

  40. Lapp GC, Brown DH, Gullane PJ, McKneally M (1998) Thoracoscopic management of chylous fistulae. Am J Otolaryngol 19(4):257–262

    Article  CAS  Google Scholar 

  41. Abdel-Galil K, Milton R, McCaul J (2009) High output chyle leak after neck surgery: the role of video-assisted thoracoscopic surgery. Br J Oral Maxillofac Surg 47(6):478–480

    Article  Google Scholar 

  42. Santaolalla F, Anta JA, Zabala A, Del Rey SA, Martinez A, Sanchez JM (2010) Management of chylous fistula as a complication of neck dissection: a 10-year retrospective review. Eur J Cancer Care 19(4):510–515

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of ORL-HNS, Command Hospital, Lucknow, Uttar Pradesh, India

    Vikas Gupta, Abhijit Basu, Kiran Upadhyay & Ritika Bhatia

  2. Department of ORL-HNS, Command Hospital, Pune, Maharashtra, India

    Gunjan Dwivedi & Uma Patnaik

  3. Department of ORL-HNS, Army Hospital (Research and Referral), New Delhi, India

    Rajeev Chugh & Devendra Kumar Gupta

  4. Department of ORL-HNS, Command Hospital, Bangalore, Karnataka, India

    Pankaj Kumar Sahu

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  1. Vikas Gupta
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Contributions

Concept and design: All Authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: All authors. Critical revision of the manuscript for important intellectual content: Vikas Gupta, Gunjan Dwivedi, Rajeev Chugh, Pankaj Sahu, Devendra Kumar Gupta, Abhijit Basu, Uma Patnaik. Administrative, technical, or material support: Vikas Gupta, Kiran Upadhyay, Ritika Bhatia. Study supervision: Vikas Gupta, Pankaj Sahu, Rajeev Chugh, Gunjan Dwivedi, Devendra Kumar Gupta.

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Gupta, V., Dwivedi, G., Chugh, R. et al. Role of Octreotide in Conservative Management of Chyle Leak Post Neck Dissection in Cases of Head Neck Cancer: A Retrospective Analysis. Indian J Otolaryngol Head Neck Surg 74 (Suppl 3), 6078–6086 (2022). https://doi.org/10.1007/s12070-021-02746-y

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