title: Postesophagectomy chylothorax: incidence, risk factors, and outcomes.
abstract: BACKGROUND
  Chylothorax is a rare but potentially lethal complication of esophagectomy. This study evaluated the rate of postesophagectomy chylothorax, identified associated risk factors, and compared postoperative outcomes in patients with and without chylothorax.
  
  
  METHODS
  We reviewed 892 consecutive patients who underwent esophagectomy (1997 to 2008). Preoperative, operative, and postoperative details, including adverse outcomes and mortality, were analyzed.
  
  
  RESULTS
  Postesophagectomy chylothorax occurred in 34 patients (3.8%). Chylothorax was significantly associated with 30-day major complications (85% vs 46%; p<0.001), including an increased likelihood of sepsis (p=0.001), pneumonia (p=0.009), reintubation (p=0.002) or reoperation (p<0.001), and death (17.7% vs 3.9%, p<0.001). Median length of stay was 17 vs 8 days (p=0.005). Median time to chylothorax diagnosis was 5 days. Thoracic duct ligation was performed in 21 (62%) at a median 13 days after esophagectomy. Two patients required repeat duct ligation for persistent chylothorax. Squamous cell cancer histology (9 of 34; 26%) was an independent predictor of postoperative chylothorax (odds ratio, 4.18; 95% confidence interval, 1.39 to 12.6). Odds of chylothorax were 36 times greater with average daily chest tube output exceeding 400 mL in the first 6 postoperative days (odds ratio, 35.9; 95% confidence interval, 8.2 to 157.8).
  
  
  CONCLUSIONS
  Postoperative chylothorax is associated with significant postoperative morbidity and mortality. Patients with squamous cell cancer may be at increased risk. In addition, average daily chest tube output exceeding 400 mL in the early postoperative period should prompt fluid analysis for chylothorax to facilitate early diagnosis and consideration of thoracic duct ligation.
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, USA.
authors.forename: Rachit D
authors.initials: RD
authors.lastname: Shah
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: Katie S
authors.initials: KS
authors.lastname: Nason
mesh_terms: D000368:Aged; D002916:Chylothorax / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome