title: A simple method minimizes chylothorax after minimally invasive esophagectomy.
abstract: BACKGROUND
  Postoperative chylothorax is a rare, but potentially fatal complication after esophagectomy. Preventive measures aimed at decreasing the incidence of chyle leakage after minimally invasive esophagectomy (MIE) could potentially reduce the high postoperative mortality associated with this complication. However, previous techniques are traumatic and time consuming. We present a simple method in the prophylaxis of chylothorax after MIE.
  
  
  METHODS
  A total of 344 consecutive esophageal cancer patients who underwent 3-stage MIE between June 2006 and July 2012 were included. Of these, 178 patients were given preoperative milk orally 6 hours before surgery (Group M+), and 166 underwent MIE without preoperative milk and served as controls (Group M-). Patient demographics were retrospectively collected. The incidences of intraoperative thoracic duct identification and postoperative chylothorax were recorded and statistically compared between the 2 groups.
  
  
  RESULTS
  In this cohort, the 2 groups were comparable in clinical features including age, sex, tumor location, histologic type, and TNM stage. No patient was converted to open thoracotomy. During the thoracoscopic stage, a higher incidence of duct identification (95.5% vs 12.7%, p < 0.001) and a lower incidence of duct ligation (6.74% vs 13.25%, p = 0.039) were recorded in Group M+. Postoperatively, a total of 10 cases of chylothorax (2.91%) were observed. The incidence of chylothorax was significantly lower in Group M+ than in Group M- (0.56% vs 5.42%, p = 0.018).
  
  
  CONCLUSIONS
  Preoperative oral administration of milk facilitates visualization of the thoracic duct and minimizes the risk of iatrogenic injury to the thoracic duct during thoracoscopic esophagectomy. It is a simple and safe method for preventing chyle leakage after MIE. A randomized and controlled trial is required to confirm these findings.
authors.affiliation: Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yaxing
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Mingxiang
authors.initials: M
authors.lastname: Feng
authors.affiliation: University College Hospital, London, United Kingdom.
authors.forename: Muhammad Asim
authors.initials: MA
authors.lastname: Khan
authors.affiliation: Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: Tan.lijie@zs-hospital.sh.cn.
authors.forename: Lijie
authors.initials: L
authors.lastname: Tan
authors.affiliation: Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D000818:Animals; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002916:Chylothorax / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004326:Drinking; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008892:Milk; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013906:Thoracoscopy; D016896:Treatment Outcome