Universität zu Köln

Brinkmann, Sebastian, Schroeder, Wolfgang, Junggeburth, Kristina, Gutschow, Christian A., Bludau, Marc, Hoelscher, Arnulf H. and Leers, Jessica M. (2016). Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus. J. Thorac. Cardiovasc. Surg., 151 (5). S. 1398 - 1405. NEW YORK: MOSBY-ELSEVIER. ISSN 1097-685X

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Abstract

Objective: Chylothorax is a major complication after esophagectomy. As recent studies refer to heterogeneous patient cohorts and surgical procedures, this study was conducted to report the incidence and evaluate the optimal management of chylous fistula in patients treated with transthoracic esophagectomy and 2 -field lymphadenectomy for esophageal cancer. Methods: From January 2005 to December 2013, a total of 906 patients underwent transthoracic esophageal resection for esophageal carcinoma at our institution. En bloc esophagectomy was performed with routine supradiaphragmatic ligation of the thoracic duct. The incidence of chylothorax, and associated morbidity and mortality, were analyzed, and subsequent therapeutic management was reviewed. Results: Chylothorax after Ivor Lewis esophagectomy was observed in 17 (1.9%) patients. Fifteen patients required surgical intervention with rethoracotomy and repeat duct ligation. Thoracic duct ligation was successful in all patients. Two patients died within 90 days after primary esophageal resection. The median time between initial tumor resection and rethoracotomy was 13 days. Average daily chest-tube output at time of reoperation was 1900 mL. In 2 patients, pleural effusion did not exceed 1000 mL per day. In these cases, conservative management with additional thoracic drainage and total parenteral nutrition led to complete resolution of chylous fistula. Conclusions: Occurrence of chylothorax after prophylactic thoracic duct ligation during transthoracic esophagectomy for esophageal cancer is rare. In patients with high -output chylous fistula, an early rethoracotomy with repeat ligation of the thoracic duct is safe and helps to shorten recovery time. In cases of low-volume drainage, a conservative approach is feasible.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Brinkmann, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Schroeder, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Junggeburth, Kristina UNSPECIFIED UNSPECIFIED UNSPECIFIED Gutschow, Christian A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bludau, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoelscher, Arnulf H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Leers, Jessica M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-277457
DOI:	10.1016/j.jtcvs.2016.01.030
Journal or Publication Title:	J. Thorac. Cardiovasc. Surg.
Volume:	151
Number:	5
Page Range:	S. 1398 - 1405
Date:	2016
Publisher:	MOSBY-ELSEVIER
Place of Publication:	NEW YORK
ISSN:	1097-685X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language THORACIC-DUCT LIGATION; POSTOPERATIVE CHYLOTHORAX; MASS LIGATION; PREVENTION; EXPERIENCE; RESECTION; IMPACT; ADENOCARCINOMA; CHILDREN; SURVIVAL Multiple languages Cardiac & Cardiovascular Systems; Respiratory System; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27745