title: The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection.
abstract: BACKGROUND
  Our objective was to determine the incidence and optimal management of chylothorax after pulmonary resection with complete thoracic mediastinal lymph node dissection (MLND).
  
  
  METHODS
  This is a retrospective review of patients who underwent pulmonary resection with MLND.
  
  
  RESULTS
  Between January 2000 and December 2012, 2,838 patients underwent pulmonary resection with MLND by one surgeon (RJC). Forty-one (1.4%) of these patients experienced a chylothorax. Univariate analysis showed that lobectomy (p<0.001), a robotic approach (p=0.03), right-sided operations (p<0.001), and pathologic N2 disease (p=0.007) were significantly associated with the development of chylothorax. Multivariate analysis showed that lobectomy (p=0.011), a robotic approach (p=0.032), and pathologic N2 disease (p=0.027) remained predictors. All patients were initially treated with cessation of oral intake and 200 μg subcutaneous somatostatin every 8 hours. If after 48 hours the chest tube output was less than 450 mL/day and the effluent was clear, patients was given a medium-chain triglyceride (MCT) diet and were observed for 48 hours in the hospital. If the chest tube output remained below 450 mL/day, the chest tube was removed, they were discharged home with directions to continue the MCT diet and to return in 2 weeks. Patients were instructed to consume a high-fat meal 24 hours before their clinic appointment. If the patient's chest roentgenogram was clear at that time, they were considered "treated." This approach was successful in 37 (90%) patients. The 4 patients in whom the initial treatment was unsuccessful underwent reoperation with pleurodesis and duct ligation.
  
  
  CONCLUSIONS
  Chylothorax after pulmonary resection and MLND occurred in 1.4% of patients. Its incidence was higher in those with pathologic N2 disease and those who underwent robotic resection. Nonoperative therapy is almost always effective.
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: abryant@uab.edu.
authors.forename: Ayesha S
authors.initials: AS
authors.lastname: Bryant
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Minnich
authors.affiliation: Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wei
authors.affiliation: Section of Thoracic Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Robert James
authors.initials: RJ
authors.lastname: Cerfolio
mesh_terms: D000328:Adult; D000368:Aged; D000407:Alabama / Q000453:epidemiology; D015505:Chest Tubes; D002916:Chylothorax / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D018700:Pleurodesis / Q000379:methods*; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult