Improving the management of cervical chyle leak following neck dissection

The aim of this study is to assess outcomes in managing post-operative chyle leaks, following neck dissection using a volume-based risk stratification algorithm.

A retrospective series (2010-2024) at a tertiary head and neck centre included all patients with chyle leaks after neck dissection for malignancy. Chyle leaks were stratified as low, medium or high volume and managed either medically or with planned intervention, video-assisted thoracoscopic surgery, thoracic duct ligation or thoracic duct embolisation.

Thirty-five patients were identified. Sixty-five point seven per cent (n = 23) with low-volume leaks resolved with conservative management, 31.4 per cent (n = 11) with moderate-/high-volume leaks underwent video-assisted thoracic duct ligation, with 10/11 resolving within one day post-operatively, 5.7 per cent (n = 2) underwent thoracic duct embolisation. All cases with ongoing chyle leaks resolved without neck re-exploration surgery.

Volume-based risk stratification, paired with early video-assisted thoracoscopic surgery ligation or embolisation, provides a highly effective, low-morbidity strategy for managing post-operative chyle leaks.