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Chylothorax after oesophagectomy.

C Bolger1, T N Walsh, W A Tanner

  • 1Trinity College Department of Surgery, St. James's Hospital, Dublin, Ireland.

The British Journal of Surgery
|May 1, 1991
PubMed
Summary
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Transhiatal oesophagectomy significantly increases the risk of chylothorax, a rare but serious complication. This condition has a high mortality rate regardless of treatment approach.

Area of Science:

  • Thoracic Surgery
  • Gastrointestinal Oncology
  • Surgical Complications

Background:

  • Chylothorax is an infrequent complication following oesophagectomy.
  • Previous studies have not established clear risk factors for chylothorax post-esophagectomy.

Purpose of the Study:

  • To investigate the incidence and risk factors of chylothorax after oesophagectomy.
  • To evaluate the outcomes of different management strategies for post-oesophagectomy chylothorax.

Main Methods:

  • Retrospective review of 537 oesophageal resections.
  • Analysis of patient demographics, tumor characteristics, operative procedures, and treatment outcomes.
  • Comparison of chylothorax incidence between transhiatal and transthoracic oesophagectomy approaches.

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Main Results:

  • An overall incidence of 2.0% for chylothorax was observed.
  • Transhiatal oesophagectomy was associated with a significantly higher incidence (10.5%) compared to transthoracic procedures (0.2%).
  • No correlation was found with tumor characteristics, but operative approach was a significant factor.
  • Conservative management (chest drainage, parenteral nutrition) was successful in 50% of cases.
  • Surgical intervention (thoracotomy and duct ligation) was successful in 2 out of 3 patients.
  • The overall mortality rate for chylothorax in this series was high at 46%.

Conclusions:

  • Transhiatal oesophagectomy substantially elevates the risk of developing chylothorax.
  • Chylothorax following oesophagectomy is associated with a high mortality rate.
  • Careful consideration of surgical approach is warranted to minimize the risk of this complication.