title: Selective En Masse Ligation of the Thoracic Duct to Prevent Chyle Leak After Esophagectomy.
abstract: BACKGROUND
  Postoperative chylothorax remains an important cause of reoperation and prolonged hospital stay after esophagectomy for the treatment of esophageal carcinoma. Chylothorax is potentially life threatening and difficult to manage. The benefit of routine thoracic duct ligation is controversial. A promising alternative is to identify chyle leaks at the time of esophagectomy and perform the ligation selectively. We developed a novel technique to identify chyle leak at the time of esophagectomy and compared it with routine ligation of thoracic duct.
  
  
  METHODS
  This cohort study involved all of the qualified patients with resectable esophageal carcinoma treated between March 1, 2011, and December 31, 2015, by a single surgical team at West China Hospital. Patients receiving routine en masse ligation of the thoracic duct were assigned to group A, and patients receiving selective en masse ligation of the thoracic duct were assigned to group B. All patients in the selective ligation group received 120 mL olive oil orally before the operation. The end point included frequencies of chyle leak detected at the time of esophagectomy, postoperative chylothorax, and need for chylothorax-related reoperation.
  
  
  RESULTS
  The study enrolled 296 patients who fulfilled the study requirement: 55 in group A and 241 in group B. Patients in group A experienced significantly higher incidences of postoperative chylothorax and chylothorax-related reoperation than group B (9.1% vs 0% [p < 0.01] and 3.6% vs 0% [p < 0.01]). Incidence of detection of intraoperative chyle leak (chylothorax plus chylous ascites) was significantly higher in group B than in group A (9.5% vs 0%, p < 0.01). No intraoperative or postoperative complications related to preoperative oral olive oil administration or selective en masse ligation of the thoracic duct were observed.
  
  
  CONCLUSIONS
  Our method of selective en masse ligation of the thoracic duct during esophagectomy was feasible and safe and was associated with reduced rates of postoperative chylothorax.
authors.affiliation: Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China. Electronic address: linyidan@scu.edu.cn.
authors.forename: Yidan
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Thyroid and Breast Surgery Department, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Li
authors.affiliation: Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.affiliation: Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xiaolong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Hanyu
authors.initials: H
authors.lastname: Deng
authors.affiliation: Information Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Yang
authors.affiliation: Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Lunxu
authors.initials: L
authors.lastname: Liu
mesh_terms: D002916:Chylothorax / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D000069463:Olive Oil; D011183:Postoperative Complications / Q000517:prevention & control; D013897:Thoracic Duct / Q000601:surgery*
chemical_list: D000069463:Olive Oil