title: Chylothorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis.
abstract: BACKGROUND
  Esophagectomy is a challenging operation with considerable potential for postoperative complications, including chylothorax.
  
  
  METHODS
  Because no randomized controlled trial or metaanalysis is available to clarify the incidence of chylothorax in esophageal cancer surgery, the authors analyzed their own institutional data for 1,856 patients and performed a systematic review using the MEDLINE database (9,794 patients) to identify risk factors, compare success rates of therapeutic approaches, and investigate long-term outcomes.
  
  
  RESULTS
  The overall institutional chylothorax rate was 2 % (n = 39). Reoperation was performed for 69 % of the patients. No significant difference was noted between the transthoracic and transhiatal approaches. Regression analysis showed neoadjuvant treatment (odds ratio [OR], 0.302; p = 0.001) and tumor type (OR, 0.304; p = 0.002) to be independent risk factors. The systematic review included 12 studies. Chylothorax occurred for 2.6 % of the patients. Treatment favored reoperation in five studies (70-100 %) and a conservative approach in four studies (58-72 %), with equal mortality rates. No significant difference was found between the transthoracic and transhiatal approaches.
  
  
  CONCLUSIONS
  Chylothorax rates are low in high-volume centers (2-3 %). No significant difference was noted between the transthoracic and transhiatal approaches. Neoadjuvant treatment and tumor type were shown to be independent risk factors. Treatment concept (reoperation vs conservative treatment) did not affect long-term survival.
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany, michael.kranzfelder@tum.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Kranzfelder
authors.forename: Ralf
authors.initials: R
authors.lastname: Gertler
authors.forename: Alexander
authors.initials: A
authors.lastname: Hapfelmeier
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Marcus
authors.initials: M
authors.lastname: Feith
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery / Q000628:therapy; D059248:Chemoradiotherapy / Q000009:adverse effects; D002916:Chylothorax / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery / Q000628:therapy; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013897:Thoracic Duct / Q000293:injuries*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents