Prophylactic fat-free diet in patients undergoing lobectomy for lung cancer does not decrease postoperative...

Reliable measures to prevent chylothorax following lobectomy are lacking. Herein a case-control study was conducted to investigate the effect of prophylactic fat-free diet on the incidence of chylothorax after thoracoscopic lobectomy and systemic lymph node dissection (SLND) for lung cancer.

Between January 2015 and December 2017, the patients with primary non-small cell lung cancer who underwent lobectomy and SLND were retrospectively reviewed. Patients in the prophylactic group started fat-free diet one week before the surgery until removal of the chest tubes after the operation; while those in the control group took normal diet unless the onset of chylothorax. Logistic regression analysis was utilized to identify the predictive factors of chylothorax following lobectomy.

The data of 110 patients in the control group and 115 cases in the prophylactic group were collected. The patients in prophylactic group showed less intraoperative blood loss [(79.9±48.7) mL vs. (100.9±55.6) mL, p=0.003], reduced postoperative drainage volume [(504.3±268.0) mL vs. (714.1±618.5) mL, p=0.001], and shorter chest tube duration [(3.6±1.7) days vs. (4.2±2.6) days, p=0.014]; however, a similar incidence of chylothorax [3 (2.6%) vs. 7 (6.4%), p=0.207] was recorded. Multivariate logistic regression analysis indicated that neoadjuvant therapy was an independent positive factor of chylothorax (odd ratio [OR] = 9.257; 95% confidence interval [CI] 1.434-59.773, p=0.019); whereas high-volume experience of the surgeon was an independent negative factor of this complication (OR = 0.129; 95% CI 0.017-0.982, p=0.048).

Prophylactic fat-free diet does not decrease the incidence of chylothorax after lobectomy. Further well-designed trials are warranted to verify this occasional finding.