title: Chylous fistula after axillary lymph node dissection: incidence, management, and possible cause.
abstract: BACKGROUND
  Chylous fistula is a known complication in procedures such as neck dissection and aneurysm surgery. However chyle leak that develops after axillary dissection is a rare phenomenon. In this study we have evaluated the incidence, possible cause, and management of chylous fistula that develops after radical breast cancer surgeries.
  
  
  METHODS
  Chylous fistula developed in 6 of 1863 patients who underwent axillary dissection. Their records were analyzed in terms of clinical profile and management. A review of the literature regarding the thoracic duct anatomy at its termination was carried out and a hypothesis about the possible cause of chylous leak was suggested.
  
  
  RESULTS
  All 6 patients had procedures on the left side and had varied clinical stages and profiles. The chyle discharge was detected intraoperatively during the primary surgical procedure in 2 patients. The other 4 patients presented with chyle in their drains postoperatively. One patient did not respond to conservative management and underwent reexploration to seal the leak. Injury to the thoracic duct or its aberrant branches is apparently not the cause of chylous fistula in the axilla. The injury to the left subclavian duct or its tributary, which drains aberrantly into the thoracic duct through a valveless junction has been hypothesized to be the source of chyle in the axilla.
  
  
  CONCLUSIONS
  Chylous fistula is very unusual after axillary dissection. Most of the chyle leaks in the axilla are manageable through conservative methods; surgical intervention is required rarely in special situations. Injury to the left subclavian duct or its tributary is the possible cause.
authors: Department of Surgical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India. drmandy79@gmail.com
authors: Mandeep
authors: M
authors: Singh
authors: S V Suryanarayana
authors: SV
authors: Deo
authors: Nootan Kumar
authors: NK
authors: Shukla
authors: Archit
authors: A
authors: Pandit
mesh_terms: D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D002913:Chyle; D005260:Female; D005402:Fistula / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008197:Lymph Node Excision / Q000009:adverse effects*; D008206:Lymphatic Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D013897:Thoracic Duct