Effectiveness of etilefrine regimen for chylothorax after esophagectomy with thoracic duct resection

Abstract

BackgroundManagement of postoperative chylothorax generally involves nutritional regimens as well as pharmacological and surgical therapies, but a clear consensus has yet to be reached.MethodsRetrospective review of 371 patients who underwent esophagectomy for esophageal cancer was performed. They were patients with squamous cell carcinoma or adenocarcinoma of the esophagus including Siewert type I/II tumor of the esophagogastric junction who underwent subtotal esophagectomy. Of these patients, 19 patients who were diagnosed with chylothorax as a postoperative complication were enrolled in this study.ResultsConservative treatment achieved cure in 16 patients among 19 patients. The duration of chylothorax tended to be longer in the no-etilefrine group (n = 5) than in the etilefrine group (n = 11) (27.8 vs. 11.6 days; p = 0.078). The 14 patients among 19 patients resected the thoracic duct. Etilefrine was used in 12 of these 14 patients. Among these 12 patients, 3 required surgical treatment and the remaining 9 patients were cured with conservative treatment. The duration of chylothorax was shorter in the conservative treatment group than in the surgical treatment group (11.9 vs. 36.3 days; p = 0.052). In addition, with the use of etilefrine as adjuvant therapy, cure was achieved in 9 patients (75%) without surgical intervention.ConclusionsThe findings of this study suggest that when used concurrently with conventional treatments, etilefrine facilitates early chest tube removal. In addition, post-thoracic duct resection chylothorax, which frequently requires surgical treatment because of the general less effectiveness of conservative treatments, showed high successful rate (75%) to etilefrine treatment.

First Case of Chylous Ascites after Laparoscopic Myomectomy: A Case Report with a Literature Review

“…Etilefrine acts by contracting the smooth muscle of the main lymphatic duct. In one of the biggest studies, a combination of etilefrine and octreotide showed an effectiveness of 75% [19,34,35]. If conservative measures fail, surgery should be performed (laparotomy or laparoscopy suture or clips ligation of the damaged lymphatic vessel).…”

The use of octreotide in the treatment of chylothorax

“…Furthermore, etilefrine is relatively safe because it rarely causes side effects such as headache, tachycardia, hypertension, and anxiety when used in proper dose. Ohkura et al [15] reported that the findings of their study suggest the effectiveness of etilefrine in patients with chylothorax following esophagectomy. Etilefrin (120 mg/day) was effective even in post-thoracic duct resection chylothorax, an often intractable condition that is difficult to treat conservatively.…”

Chylothorax in the neonate—A stepwise approach algorithm

“…Etilefrine , a sympathomimetic drug that causes contraction of smooth muscle fibers in the thoracic duct has been used, in combination with octreotide or not, in adult and neonatal patients with postoperative chylothorax 51–54 . Although experience with etilefrine is limited, it can be a novel option in the conservative treatment of neonatal chylothorax.…”