title: A 2-wk conservative treatment regimen preceding thoracic duct ligation is effective and safe for treating post-esophagectomy chylothorax.
abstract: BACKGROUND
  Chylothorax is a pathologic condition defined by an accumulation of lymphatic fluid, the chyle, in the thorax. Postoperative chylothorax is a potentially lethal complication, with a reported mortality rate of 15.4%-25%.
  
  
  METHODS
  Esophageal cancer patients hospitalized for elective radical esophagectomy by thoracotomy (n = 10,574) were consecutively enrolled between January 1996 and December 2011. Patients (n = 306) who experienced post-esophagectomy chylothorax were assigned to a 48-h (group A, n = 186) or to a 2-wk (group B, n = 120) conservative treatment regimen. For patients with a daily chylothorax output >1000 mL, thoracic duct ligation (TDL) was performed by thoracotomy. Measured outcomes included frequency of TDL, overall and treatment-specific morbidity and mortality rates, and the rate of chylothorax recurrence.
  
  
  RESULTS
  A total of 171 patients (171 of 306 [55.9%]) underwent TDL. A larger proportion of patients in group A required TDL compared with group B (72.6% versus 30.0%, P < 0.001). Group A had a significantly higher rate of overall morbidity compared with group B (31.7% versus 19.2%, P = 0.02). Moreover, the overall mortality rate was significantly higher in group A (14.0% versus 4.2%, P = 0.006). Chylothorax recurred in nine patients (9 of 306 [2.9%]), and there was no difference between the two groups (3.2% versus 2.5%, P = 1.000).
  
  
  CONCLUSIONS
  The 2-wk regimen reduced the requirement for TDL and the overall morbidity and mortality rates compared with the 48-h regimen. Importantly, this regimen does not increase the risk of chylothorax recurrence.
authors.affiliation: Department of Thoracic Surgery, General Hospital of Chengdu Command, Chengdu, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Gang
authors.initials: G
authors.lastname: Dan
authors.forename: Jianqing
authors.initials: J
authors.lastname: Jiang
authors.forename: Yongfan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Dan
authors.initials: D
authors.lastname: Deng
mesh_terms: D000368:Aged; D002916:Chylothorax / Q000401:mortality / Q000628:therapy*; D018752:Diet, Fat-Restricted; D004322:Drainage; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D015994:Incidence; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013897:Thoracic Duct / Q000601:surgery*; D013908:Thoracotomy; D016896:Treatment Outcome
keywords: Chylothorax; Conservative treatment; Ligation; Morbidity; Mortality; Pleural cavity; Postoperative; Thoracic duct; Thrombosis