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Prophylactic ligation of the thoracic duct branch prevents chylothorax after pulmonary resection for right lung cancer

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Abstract

Purpose

Chylothorax is a rare and challenging complication of thoracic surgery. Whereas most current studies focus on postoperative treatment and preventative measures for esophageal cancer surgery, the current study investigates the impact of prophylactic ligation of the thoracic duct branch on postoperative chylothorax after pulmonary resection for right lung cancer.

Methods

The subjects of this retrospective study were 1165 patients who underwent right pulmonary resection and mediastinal lymph-node dissection in our department between January 2015 and August 2019. Those who underwent prophylactic ligation of the thoracic duct branch after 4R lymph-node dissection were assigned to group A (n = 475), and those who did not were assigned to group B (n = 690). The incidence of postoperative chylothorax, the success rate of conservative treatment, the postoperative hospital stay, and the chest drainage volume were recorded and compared statistically between the two groups.

Results

The incidence of postoperative chylothorax was significantly lower in group A than in group B (0.84% vs. 2.90%, p = 0.015). Patients who had a chylothorax in group A had a significantly shorter postoperative hospital stay, less mean drainage volume per day, and less total drainage than those in group B (7.25 ± 0.50 days vs. 11.00 ± 2.81 days, p = 0.003; 0.64 ± 0.04 L vs. 0.80 ± 0.09 L, p = 0.003; 4.64 ± 0.40 L vs. 8.82 ± 2.84 L; p = 0.002). The success rate of conservative treatment was higher in group A than in group B, but the difference was not significant (100% vs. 75.0%, p = 0.544).

Conclusion

Performing prophylactic ligation of the thoracic duct branch during right pulmonary resection and mediastinal lymph-node dissection is an effective and safe method of preventing postoperative chylothorax.

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References

  1. Lin Y, Li Z, Li G, Zhang X, Deng H, Yang X, et al. Selective en masse ligation of the thoracic duct to prevent chyle leak after esophagectomy. Ann Thorac Surg. 2017;103:1802–7.

    Article  Google Scholar 

  2. Crucitti P, Mangiameli G, Petitti T, Condoluci A, Rocco R, Gallo IF, et al. Does prophylactic ligation of the thoracic duct reduce chylothorax rates in patients undergoing oesophagectomy? A systematic review and meta-analysis. Eur J Cardiothorac Surg. 2016;50:1019–24.

    Article  Google Scholar 

  3. Lei Y, Feng Y, Zeng B, Zhang X, Chen J, Zou J, et al. Effect of prophylactic thoracic duct ligation in reducing the incidence of postoperative chylothorax during esophagectomy: a systematic review and meta-analysis. Thorac Cardiovasc Surg. 2018;66:370–5.

    Article  Google Scholar 

  4. Hou X, Fu JH, Wang X, Zhang LJ, Liu QW, Luo KJ, et al. Prophylactic thoracic duct ligation has unfavorable impact on overall survival in patients with resectable oesophageal cancer. Eur J Surg Oncol. 2014;40:1756–62.

    Article  CAS  Google Scholar 

  5. Shen Y, Feng M, Khan MA, Wang H, Tan L, Wang Q. A simple method minimizes chylothorax after minimally invasive esophagectomy. J Am Coll Surg. 2014;218:108–12.

    Article  Google Scholar 

  6. Ohkura Y, Ueno M, Shindoh J, Iizuka T, Ka H, Udagawa H. Risk factors for postoperative chylothorax after radical subtotal esophagectomy. Ann Surg Oncol. 2018;25:2739–46.

    Article  Google Scholar 

  7. Cho HJ, Kim DK, Lee GD, Sim HJ, Choi SH, Kim HR, et al. Chylothorax complicating pulmonary resection for lung cancer: effective management and pleurodesis. Ann Thorac Surg. 2014;97:408–13.

    Article  Google Scholar 

  8. Bryant AS, Minnich DJ, Wei B, Cerfolio RJ. The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg. 2014;98:232–5 (discussion 5–7).

  9. Yang F, Zhou J, Li H, Yang F, Xiao R, Chi C, et al. Near-infrared fluorescence-guided thoracoscopic surgical intervention for postoperative chylothorax. Interact Cardiovasc Thorac Surg. 2018;26:171–5.

    Article  Google Scholar 

  10. Johnson OW, Chick JF, Chauhan NR, Fairchild AH, Fan CM, Stecker MS, et al. The thoracic duct: clinical importance, anatomic variation, imaging, and embolization. Eur Radiol. 2016;26:2482–93.

    Article  Google Scholar 

  11. Pillay TG, Singh B. A review of traumatic chylothorax. Injury. 2016;47:545–50.

    Article  CAS  Google Scholar 

  12. Alamdari DH, Asadi M, Rahim AN, Maddah G, Azizi S, Shahidsales S, et al. Efficacy and safety of pleurodesis using platelet-rich plasma and fibrin glue in management of postoperative chylothorax after esophagectomy. World J Surg. 2018;42:1046–55.

    Article  Google Scholar 

  13. Takuwa T, Yoshida J, Ono S, Hishida T, Nishimura M, Aokage K, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg. 2013;146:571–4.

    Article  Google Scholar 

  14. Reisenauer JS, Puig CA, Reisenauer CJ, Allen MS, Bendel E, Cassivi SD, et al. Treatment of postsurgical chylothorax. Ann Thorac Surg. 2018;105:254–62.

    Article  Google Scholar 

  15. Li W, Dan G, Jiang J, Zhao Y, Deng D. A 2-wk conservative treatment regimen preceding thoracic duct ligation is effective and safe for treating post-esophagectomy chylothorax. J Surg Res. 2013;185:784–9.

    Article  Google Scholar 

  16. Brinkmann S, Schroeder W, Junggeburth K, Gutschow CA, Bludau M, Hoelscher AH, et al. Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus. J Thorac Cardiovasc Surg. 2016;151:1398–404.

    Article  Google Scholar 

  17. Hoeppner J, Hopt UT. Transabdominal mass ligation of the thoracic duct for the prevention of chylothorax following en bloc oesophagectomy. Eur J Cardiothorac Surg. 2013;44:1134–6.

    Article  Google Scholar 

  18. Uchida S, Suzuki K, Hattori A, Takamochi K, Oh S. Surgical intervention strategy for postoperative chylothorax after lung resection. Surg Today. 2016;46:197–202.

    Article  Google Scholar 

  19. Martucci N, Tracey M, Rocco G. Postoperative chylothorax. Thorac Surg Clin. 2015;25:523–8.

    Article  Google Scholar 

  20. Miao L, Zhang Y, Hu H, Ma L, Shun Y, Xiang J, et al. Incidence and management of chylothorax after esophagectomy. Thorac Cancer. 2015;6:354–8.

    Article  CAS  Google Scholar 

  21. Yuan Y, Chen LQ, Zhao Y. Anastomosis between thoracic duct and azygos vein during esophagectomy: a novel technique with 3-year follow-up. World J Surg. 2016;40:2984–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Panjiayuannanli No 17, Chaoyang District, Beijing, 100021, China

    Zixu Liu, Minjun Du, Yicheng Liang, Shaolong Ju, Xingkai Li & Yushun Gao

Authors
  1. Zixu Liu
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  2. Minjun Du
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  3. Yicheng Liang
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  4. Shaolong Ju
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  5. Xingkai Li
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  6. Yushun Gao
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Contributions

YG conceived and designed the experiments. ZL extracted the data. MD and YL assessed the quality of included studies. XL and SJ conducted the statistical analyses. ZL wrote the manuscript.

Corresponding author

Correspondence to Yushun Gao.

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The authors declare no conflicts of interest.

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Liu, Z., Du, M., Liang, Y. et al. Prophylactic ligation of the thoracic duct branch prevents chylothorax after pulmonary resection for right lung cancer. Surg Today 50, 881–888 (2020). https://doi.org/10.1007/s00595-020-01969-w

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  • DOI: https://doi.org/10.1007/s00595-020-01969-w

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