Chyle leak following esophagectomy: 'a retrospective 10-year single-site experience of a tertiary center'

Post-esophagectomy chyle leak following injury to the thoracic duct and/or its tributaries is a rare but well-recognized complication with a reported incidence of 0.4-21% and a mortality of 0-50%. The aim of this study was to describe our experience as a tertiary esophagogastric cancer center in managing this complication over a 10-year period. This was a retrospective study, using an electronic database, to analyze our incidence and management of chyle leak in all patients who underwent elective esophagectomy between April 2009 and December 2019 in a tertiary upper gastrointestinal cancer center. Non-normally distributed data were presented as a median and range/interquartile range with analysis being conducted using the Mann-Whitney U test. A P-value <0.05 was considered statistically significant. Between 2009 and 2019, a total of 550 patients underwent esophagectomy. Chyle leak was identified in 24 patients (4.4%); all 24 patients had neoadjuvant chemotherapy and underwent an open 2 stage Ivor Lewis esophagectomy with routine ligation of the thoracic duct at the time of operation. 83.3% (n = 20) of chyle leak patients were managed surgically with a median length of stay of 20 days (Range 11 to 148) and mortality of 5% (n = 1). 16.7% (n = 4) were managed conservatively with a median length of stay of 31 days (Range 14 to 51) and mortality of 0%. Our data are consistent with the evidence in the literature, which suggests that early surgical intervention in high volume leaks is safe and effective and low mortality rates with chyle leak can be achieved with surgical intervention. This is crucial in reducing the length of stay in hospital and morbidity. Conservative management is suitable in low volume chyle leak and cases clinically responding to medical management.