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Surgical pathology is a predictor of outcome in post-operative lymph leakage
Choon Seow1, Linda Murray, Ruth F McKee
1Department of Surgery, Tan Tock Seng Hospital, No 11, Jalan Tan Tock Seng, Singapore 308433, Singapore. choon_sheong_seow@ttsh.com.sg
Background:
Post-operative lymph leak is a potentially serious complication which may contribute to fluid and electrolyte imbalance, malnutrition and an increase risk of sepsis and mortality. We aimed to study the use of TPN in the treatment of post-operative lymph leak.
Methods:
Retrospective review of prospectively collected clinical database comprising patients with post-operative lymph leak treated with TPN collected over 1998-2006. An analysis of morbidity and mortality was performed.
Results:
36 patients developed lymph leak following radical neck dissection (n = 10), Whipples procedure (n = 13), oesophagectomy (n = 10) and pulmonary/vascular/retroperitoneal (n = 3) surgery. The survival to discharge was 89%. The mortality rate in patients with chylothorax following oesophagectomy was 30% (three out of ten). The majority of patients (67%, 24 out of 36) with lymph leak settled on TPN alone. The overall re-intervention rate was 20%. Of the seven survivors after oesophagectomy, five underwent re-intervention thoracic surgery (two also had ischaemic perforation of gastric remnant needing revision surgery). Overall, the re-intervention rate in all patients undergoing oesophageal surgery is 60%.
Conclusion:
Most patients with post-operative lymph leak receiving TPN alone survived. It is rare for re-operation to be necessary in patients who have lymph leaks in the neck or retroperitoneum. Re-operative intervention is more commonly performed in lymph leak after oesophagectomy.