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Past
In breast cancer surgery, chyle leak is a rare complication with a reported incidence of less than 0.5%.1 This could constitute a dilemma to the breast surgeon, particularly when there is paucity in evidence-based management guidelines.2 Also, it is concerning when breast cancer surgery complications can result in significant delays in adjuvant treatment.
Present
In our article,3 we report a thoughtful analysis by citing the experience of two centres in Europe: one from Italy, a tertiary referral centre and a global lead in the field of oncology, breast cancer prevention, early diagnosis and effective treatment; and another from the UK, a secondary referral breast centre and one of the largest screening programs in the West Midlands. On top of that, at both sites, this experience has included immediate breast reconstruction, which did not interfere with the successful management of chyle leak. To our knowledge, this is the first published article which combines such experience. Therefore, this would provide a key element to guide managing this complication.
Future
Future consensus for management is strongly needed; until then, conservative approach is recommended, and surgical intervention is reserved for refractory cases.
References
González-Sánchez-Migallón E, et al. Chylous fistula following axillary lymphadenectomy: benefit of octreotide treatment. Int J Surg Case Rep. 2016;2016:6098019.
Atie M, Dunn G, Falk GL. Chlyous leak after radical oesophagectomy: thoracic duct lymphangiography and embolisation (TDE)—a case report. Int J Surg Case Rep. 2016;23:12–6.
Ashoor A, Lissidini G, Datta U, Bertoldi L, Veronesi P, Tan MLH. Chyle leak after axillary node clearance in breast cancer 3 surgery—a rare complication and a proposed management 4 strategy from the british and italian experience. Ann Surg Oncol. 2022. https://doi.org/10.1245/s10434-022-12094-y.
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Ashoor, A., Lissidini, G., Datta, U. et al. ASO Author Reflections: Chyle Leak after Axillary Node Clearance in Breast Cancer Surgery, a Successful Management Approach from Leading Centres. Ann Surg Oncol 29, 8000 (2022). https://doi.org/10.1245/s10434-022-12122-x
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DOI: https://doi.org/10.1245/s10434-022-12122-x