Octreotide in the management of postoperative chylothorax

Chylothorax (KT) may be a complication of thoracic surgery. Its management is not well established and may comprise dietary interventions and surgery. The effectiveness of somatostatin and its analogues has been reported, although their mechanism(s) of action is unclear. We report our experience with octreotide in a series of patients with postoperative chylothorax. Eight patients with KT were treated with a continuous intravenous infusion of octreotide (OCT) at a starting dose of 0.5 microg/kg/hr. They were compared with four additional patients with KT who were treated according to the conventional approach. After a mean of 3.3 +/- 1.9 days of treatment, fluid discharge diminished dramatically. In all patients, fluid losses stopped by postoperative day 10.5 +/- 2.9 and chest tubes could be removed after 12.8 +/- 4.1 days. Compared to a small group of historical controls, OCT reduced significantly the total fluid losses (141.1 +/- 89.3 vs 396.7 +/- 151.0 ml/kg; p = 0.003) and the postoperative length of stay (p = 0.05). No patients in the group treated with OCT required parenteral nutrition (compared to all four of the controls; p = 0.002) and/or thoracenteses (compared to two of four controls). In postoperative KT, OCT seems to be at least as effective as the conventional approach. Furthermore, OCT may reduce total fluid losses and postoperative length of stay. This may have a beneficial effect on the risk of complications and on hospital costs.