Incidence and management of chylothorax after esophagectomy.
BACKGROUND
Chylothorax is a rare but serious postoperative complication in esophageal cancer patients. The aim of this study was to identify risk factors associated with chylothorax and the indication for surgical intervention.


METHODS
A consecutive series of 1290 patients who underwent esophagectomy for esophageal cancer was included. Peri-operative data, including postoperative morbidity and mortality, were analyzed.


RESULTS
Thirty-four patients (2.6%) developed chylothorax and had significantly higher instances of pneumonia (26.5% vs. 11.1%, P = 0.012) and arrhythmia (17.6% vs. 2.9%, P = 0.001), and a longer hospital stay (22 vs. 18 days, P < 0.001). Reoperation was performed in 11 patients at a rate of 77.8%, 42.9%, 20%, and 0% for chylothorax diagnosed in two, three, four, and >= 5 days, respectively, after esophagectomy (P < 0.001). After three days of conservative therapy, the chest tube output was significantly greater in patients whose medical management had failed than in those successfully treated (P < 0.001). All patients who required reoperation had >= 13.5 ml/kg of drainage (sensitivity 100%); four of 23 patients with successful medical management had a chest tube output >= 13.5 ml/kg (specificity 83%). Logistic regression analysis showed that body mass index (BMI) < 25 was an independent risk factor for chylothorax (hazard ratio = 9.256, P = 0.029).


CONCLUSIONS
Patients with a BMI < 25 are more likely to develop chylothorax after esophagectomy. Operative therapy should be seriously considered in patients who develop chylothorax early postoperatively. In addition, a high daily chylous output of >= 13.5 ml/kg after three days of conservative therapy might be a reliable indicator for reoperation.
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, China.
Longsheng
L
Miao
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, China.
Yawei
Y
Zhang
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, China.
Hong
H
Hu
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, China.
Longfei
L
Ma
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, China.
Yihua
Y
Shun
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, China.
Jiaqing
J
Xiang
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center Shanghai, China ; Department of Oncology, Shanghai Medical College, Fudan University Shanghai, China.
Haiquan
H
Chen
Chyle; complications; esophageal cancer; surgery