Anatomic Landmarks for the Cervical Portion of the Thoracic Duct

Abstract

Through an increased appreciation for its location, injury to the thoracic duct may be minimized.

Institutional experience with lateral neck dissections for thyroid cancer

“…The terminal arch of the thoracic duct (Fig 1, B) can be found anywhere #4 cm above the clavicle before $1 branches insert into the internal jugular vein. 16,17 The incidence of chyle leak in our cohort was approximately 6%, which is comparable with previously published data that have cited rates of 1-8%. [8][9][10]17 In the current study, surgical drains were used in 93 patients, which allowed for early detection of chyle leaks, characterized by the change in output consistency and volume.…”

“…Reoperation was curative in both patients and they were discharged on postoperative day 2. Chyle leak patients required drains for a median duration of 12 days (range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], which was significantly longer than in patients without chyle leak (median, 6 days; range, 2-16; P < .01). There was no association found between drain duration and the risk of SSI.…”

Bilateral chylothorax following reoperative central neck dissection for metastatic papillary thyroid cancer

“…The duct can also terminate at multiple sites with many people having up to three terminal vessels 7. The cervical portion of the thoracic duct can be as high as 3.5 cm superior to the sternal notch and only 2 cm lateral to the midline 8. Furthermore, due to our patient undergoing reoperative neck dissection in the setting of recurrent regional thyroid cancer, the chylothorax may be caused by any type of injury of the chyle duct due to tissue fibrosis as a result of her initial surgery.…”

Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment

“…Priority must be given to the prevention of lymph fistulas related to an injury of the main thoracic duct or one of its multiple branches (40% of cases) [3, 6, 8, 10]. A meticulous surgical technique combined with magnifying glasses has recently been advocated by Lorenz et al [6].…”

“…Advances in surgeons’ knowledge of the anatomic landmarks and variability of the cervical portion of the thoracic duct should minimize the incidence of injuries which lead to an often unrecognized but significant morbidity rate [10]. …”