Chyle Leak Following Axillary Lymph Node Clearance - a Benign Complication: Review of the Literature

SUMMARY: CASE REPORT: An 82-year-old patient underwent a mastectomy and axillary lymph node clearance for a large multicentric lobular cancer of the left breast. On day 11 after her operation, white viscous fluid was noted in her axillary drain. METHODS: We analysed case reports in the literature, noting the interval between surgery and diagnosis of chyle, the duration of the chyle leak, the volume of chyle during the first 24 h, the median volume and the administered treatment. RESULTS: 25 cases were reported in 13 publications. Our case was unusual in that chyle was noted 11 days after surgery. In most cases, chyle leakage subsides spontaneously by simply leaving the drain in situ. CONCLUSIONS: A conservative observant approach appears appropriate in most cases. Only for persistent and large-volume leaks, dietary intervention (medium-chain lipid diet, nil by mouth, total parenteral nutrition) is justified. Surgery with re-exploration of the axilla and oversewing of the chyle duct can be used as the last reserve for persistent chyle leaks.