Lymphatic Interventions for Chylothorax: A Systematic Review and Meta-Analysis.

Area of Science:

• Interventional Radiology
• Thoracic Surgery
• Gastroenterology

Background:

• Chylothorax, a rare condition characterized by the accumulation of lymphatic fluid in the pleural space, presents significant therapeutic challenges.
• Current treatment strategies for chylothorax vary, with a need for effective and less invasive options.

Purpose of the Study:

• To systematically review and meta-analyze published studies evaluating the efficacy of lymphatic interventions for chylothorax.
• To assess the technical and clinical success rates, as well as complication rates, of specific lymphatic interventions.

Main Methods:

• A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was conducted for English-language studies up to March 2017.
• Studies included patients with chylothorax treated with lymphangiography (LAG), thoracic duct embolization (TDE), or thoracic duct disruption (TDD).
• Exclusion criteria included sample sizes less than 10 patients, lack of extractable data, or duplicate reporting.

Main Results:

• Data from 9 studies involving 407 patients were analyzed.
• Pooled technical success rates were 94.2% for LAG and 63.1% for TDE.
• Pooled clinical success rates (per-protocol) were 56.6% for LAG, 79.4% for TDE, and 60.8% for TDD. Overall clinical success (intention-to-treat) was 60.1%.
• Pooled major complication rates were 1.9% for LAG and 2.4% for TDE.

Conclusions:

• Lymphatic interventions demonstrate respectable efficacy in the management of chylothorax.
• The choice of intervention and the underlying etiology of chylothorax can influence treatment success.
• Further research may be warranted to optimize treatment protocols and outcomes.