title: Use of Octreotide for the Management of Chyle Fistula Following Neck Dissection.
abstract: OBJECTIVE
  Chyle fistula is an uncommon complication of neck surgery. A variety of management strategies have been described, including diet restriction, parenteral nutrition, use of pressure dressings, and revision surgery. Octreotide has been used with success in patients with neck and thoracic chyle fistulas, but data regarding efficacy in neck chyle fistulas are lacking.
  
  
  OBJECTIVE
  To evaluate the efficacy of octreotide for use in patients with postoperative chyle fistulas.
  
  
  METHODS
  Retrospective review of 12 patients who received octreotide for neck chylous fistula after neck dissection was performed during the period 2004 through 2014 at 2 tertiary care academic hospitals.
  
  
  METHODS
  Patients with postoperative neck chyle fistulas were given a restricted diet and subcutaneous octreotide.
  
  
  METHODS
  The main outcome was fistula closure rate, defined as fistula resolution without surgical intervention. Secondary outcomes of fistula duration (days from detection until resolution), length of hospital stay (surgery to discharge), and treatment complications were also examined.
  
  
  RESULTS
  All 12 patients had resolution of their neck chyle fistula with octreotide therapy without need for revision surgery. Mean (SD) hospital stay was 8.7 (4.76) days, with a range of 3 to 18 days. The chyle fistula resolved after a mean (range) 5.5 (2-11) days. Self-resolving nausea was encountered in 1 patient from octreotide use, and 1 patient developed a salivary fistula as a result of the chylous fistula.
  
  
  CONCLUSIONS
  In these patients, octreotide was safe and effective in resolving neck chylous fistulas. Octreotide therapy appears superior to traditional conservative measures of diet restriction and pressure dressings when compared with literature rates. A prospective study is needed to confirm results, but octreotide therapy should be considered as first-line conservative management for neck chyle fistulas that occur after neck surgery.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Swanson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles.
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Hudson
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Nipun
authors.initials: N
authors.lastname: Bhandari
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles.
authors.forename: Uttam K
authors.initials: UK
authors.lastname: Sinha
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles.
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Maceri
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles.
authors.forename: Niels
authors.initials: N
authors.lastname: Kokot
mesh_terms: D000328:Adult; D000368:Aged; D002913:Chyle; D005260:Female; D005402:Fistula / Q000188:drug therapy* / Q000209:etiology; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects*; D015282:Octreotide / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D015282:Octreotide