Risk Factors for Postoperative Chylothorax After Radical Subtotal Esophagectomy

Abstract

Background

Chylothorax is one of the complications of esophagectomy for esophageal cancer. The treatment of this condition has been well discussed, but the risk factors for postoperative chylothorax remain unclear.

Methods

A retrospective review of 294 patients who underwent esophagectomy for esophageal cancer was conducted. These were patients with squamous cell carcinoma or adenocarcinoma of the esophagus including Siewert type I tumor of the esophagogastric junction who underwent subtotal esophagectomy with two-field or three-field lymphadenectomy. Of these, 24 patients who were diagnosed with chylothorax as a postoperative complication were allocated to the chylothorax group and the other 270 patients were allocated to the nonchylothorax group.

Results

Univariate analysis showed a significant difference in three factors: resection of thoracic duct, post-chemoradiotherapy, and high intraoperative fluid balance. Multivariate analysis revealed that post-chemoradiotherapy [hazard ratio (HR) = 3.430; 95% confidence interval (CI) 1.364–8.625] and high intraoperative fluid balance (HR = 1.569; 95% CI 1.2.7–2.039) were independent factors predicting chylothorax. In addition, resection of the thoracic duct may be a predictor of chylothorax after esophagectomy (HR = 3.389; 95% CI 0.941–12.201, p = 0.062). Receiver operating characteristic curve analysis of intraoperative fluid revealed that the sensitivity was 62.5%, specificity was 74.1%, and the cutoff value was 6.55 mL/kg/h.

Conclusions

This study revealed that post-chemoradiotherapy and high intraoperative fluid balance are predictors of chylothorax after esophagectomy. The elucidation of clinicopathological factors that can predict the incidence of chylothorax will help to establish more effective perioperative management for esophageal cancer patients.

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Authors

Contributions

Yu Ohkura, Masaki Ueno, and Junichi Shindoh designed the study, wrote the manuscript, revised it critically for important intellectual content, and gave final approval for the content; Yu Ohkura, Masaki Ueno, Masaki Ueno, Toshiro Iizuka, Hairin Ka and Harushi Udagawa created study materials or recruited patients.

Corresponding author

Correspondence to Yu Ohkura MD.

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The authors declare that they have no conflict of interest.

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Ohkura, Y., Ueno, M., Shindoh, J. et al. Risk Factors for Postoperative Chylothorax After Radical Subtotal Esophagectomy. Ann Surg Oncol 25, 2739–2746 (2018). https://doi.org/10.1245/s10434-018-6640-1

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Keywords

  • Postoperative Chylothorax
  • Subtotal Esophagectomy
  • Intraoperative Fluid Balance
  • Three-field Lymphadenectomy
  • Video-assisted Thoracoscopic Surgery (VATS)