Chyle Leakage after Esophageal Cancer Surgery

Abstract

Surgeons recommend dissecting lymph nodes in the thorax, abdomen, and neck during surgery for esophageal cancer because of the possibility of metastasis to the lymph nodes in those areas through the lymphatic plexus of the esophageal submucosal layer. Extensive lymph node dissection is essential for accurate staging and is thought to improve survival. However, it can result in several complications, including chyle leakage, which refers to continuous lymphatic fluid leakage and can occur in the thorax, abdomen, and neck. Malnutrition, fluid imbalance, and immune compromise may result from chyle leakage, which can be potentially life-threatening if it persists. Therefore, various treatment methods, including conservative treatment, pharmacological treatment such as octreotide infusion, and interventions such as thoracic duct embolization and surgical thoracic duct ligation, have been applied. In this article, the risk factors, diagnosis, and treatment methods of chyle leakage after esophagectomy are reviewed.

Treatment of Refractory Chylous Ascites with an Innovative Peritoneovenous Shunt: Temporary Usage of a Continuous Renal Replacement System: A Case Report

“…The points of lymphatic leakage are difficult to locate visually. Furthermore, complete ligation of the lymphatic ducts is uncertain because the ducts have complex connections [3]. Furthermore, the cisterna chyli, which is the main pathway of the lymphatic duct in the peritoneum, is not easily visualized.…”

Evaluation of Intraoperative Navigation-assisted Thoracoscopic Oesophagectomy Outcomes in the Patient's Semi-prone Position

“…Unnoticed injury of the thoracic lymphatic duct resulted in massive chylothorax, requiring repeated surgical interventions. Therefore, many authors perform clipping of the stump of the thoracic lymphatic duct to prevent its accidental damage rather than pursuing the aims of oncological radicality [27,30].…”

Hospital Variation in Feeding Jejunostomy Policy for Minimally Invasive Esophagectomy: A Nationwide Cohort Study

“…The higher chyle leakage rate could be caused by the continuous challenge of the bowel with intralipids by tube feeding compared to other forms of feeding. This causes more fat to be digested and subsequently transported through the lymph system, resulting in increased flow in the thoracic duct [ 27 ].…”