A simple method minimizes chylothorax after minimally invasive esophagectomy

Area of Science:

• Thoracic surgery
• Surgical oncology
• Gastrointestinal surgery

Background:

• Postoperative chylothorax is a rare but serious complication following esophagectomy.
• Minimally invasive esophagectomy (MIE) aims to reduce mortality, but chyle leakage remains a concern.
• Existing preventive techniques for chyle leakage are often invasive and time-consuming.

Purpose of the Study:

• To evaluate a novel, simple method for preventing chylothorax after MIE.
• To assess the efficacy of preoperative oral milk administration in reducing chyle leakage.
• To compare the incidence of chylothorax in patients receiving milk versus a control group.

Main Methods:

• A retrospective study of 344 patients undergoing 3-stage MIE for esophageal cancer.
• Group M+ (178 patients) received oral milk 6 hours pre-surgery; Group M- (166 patients) served as controls.
• Intraoperative thoracic duct identification and postoperative chylothorax rates were compared.

Main Results:

• Preoperative milk significantly improved thoracic duct identification (95.5% vs 12.7%, p < 0.001) and reduced duct ligation (6.74% vs 13.25%, p = 0.039).
• The overall incidence of chylothorax was 2.91% (10 cases).
• Chylothorax incidence was significantly lower in Group M+ (0.56%) compared to Group M- (5.42%, p = 0.018).

Conclusions:

• Preoperative milk intake facilitates thoracic duct visualization during MIE.
• This simple and safe method effectively minimizes the risk of iatrogenic thoracic duct injury and chyle leakage.
• Further randomized controlled trials are recommended to validate these findings.