Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus

Brinkmann, S; Schröeder, Wolfgang; Junggeburth, Kristina; Gutschow, Christian A.; Bludau, Marc; Hoelscher, Arnulf H.; Leers, Jessica M.

doi:10.1016/j.jtcvs.2016.01.030

Cited by 65 publications

(55 citation statements)

References 36 publications

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“…Our results were similar to another retrospective report, in which a significantly higher incidence of vocal cord paralysis was associated with the McKeown MIE (11). For transthoracic esophagectomy, chylothorax is a well-known complication associated with high morbidity and mortality (12). A randomized controlled trial and a meta-analysis have reported that transthoracic esophagectomy is associated with a high incidence of pulmonary complications and chyle leakage and longer hospital stays (13,14).…”

Section: Discussionsupporting

confidence: 89%

Perioperative management and outcomes of minimally invasive esophagectomy: case study of a high-volume tertiary center in Taiwan

et al. 2018

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Background: Mortality and complication rates for surgical esophagectomy remain high despite progress in surgical techniques and perioperative care. Minimally invasive surgery and intraoperative goal-directed fluid management are gaining popularity in Taiwan; however, perioperative complications and shortterm outcomes have been rarely reported. In this retrospective study, we analyzed the surgical procedures performed as well as the perioperative outcomes and treatments after esophagectomy in a high-volume medical center in Taiwan Although McKeown MIE bore a significantly longer surgical time and higher intraoperatively-infused crystalloid than did Ivor Lewis MIE, there were no significant differences regarding postoperative cardiothoracic complications and patient outcomes. Conclusions: Postoperative outcomes of McKeown MIE and Ivor-Lewis MIE were comparable in our center and short term outcomes were similar to those in previous reports. However, despite neoadjuvant concurrent chemoradiation therapy (CCRT), the use of minimally invasive techniques, and well-controlled anesthesia, the incidence of perioperative complications remains high. Our results suggest that patients with preoperative comorbidity of arrhythmia, heart diseases, and CKD are associated with more common postoperative complications. Furthermore, postoperative dysrhythmias, pulmonary complications, and AKI warrant special anesthetic and surgical care to prevent prolonged ICU stay.

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Section: Discussionsupporting

confidence: 89%

Perioperative management and outcomes of minimally invasive esophagectomy: case study of a high-volume tertiary center in Taiwan

et al. 2018

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“…In the modern era of upper gastrointestinal surgery, postoperative chylothorax is a dramatic complication that occurs between 1% and 9% of the time after esophagectomy for cancer . Although a rare event, chylothorax affects the postoperative morbidity by promoting the occurrence of pneumonia, with respiratory failure, malnutrition, and death in 20% of cases .…”

Section: Other Complications That May Influence the Conduit Or Anastomentioning

confidence: 99%

“…Postoperative chylothorax can be classified into three categories according to the daily output (volume/kg): low, medium, and high drain output . Brinkmann et al .…”

Section: Other Complications That May Influence the Conduit Or Anastomentioning

confidence: 99%

“…120,121 Indications for lymphangiography in the treatment of chylothorax after esophagectomy In the modern era of upper gastrointestinal surgery, postoperative chylothorax is a dramatic complication that occurs between 1% and 9% 122-124 of the time after esophagectomy for cancer. [123][124][125] Although a rare event, chylothorax affects the postoperative morbidity by promoting the occurrence of pneumonia, with respiratory failure, malnutrition, and death in 20% of cases. 125 Currently, the debate is not completely resolved whether to perform systematic dissection of the thoracic duct, although this practice can prevent the occurrence of severe chylothorax.…”

Section: Pathophysiology Of Postoperative Pulmonary Complicationmentioning

confidence: 99%

“…Postoperative chylothorax can be classified into three categories according to the daily output (volume/kg): low, medium, and high drain output. 124 Brinkmann et al and Dugue et al advocate a daily output threshold of 10 mL/kg body weight before considering thoracic duct ligation, 124,127 but the timing for surgical revision after failure of conservative treatment, which can include total parenteral nutrition or medium chain triglyceride diets, is still unclear. [128][129][130] Among patients with high or medium output chylothorax, high mortality rates associated with nonoperative management dictate earlier surgical revision, which has clinical success of up to 100%.…”

Section: Pathophysiology Of Postoperative Pulmonary Complicationmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis, assessment, and management of surgical complications following esophagectomy

Grimminger

Goense

Gockel

et al. 2018

Annals of the New York Academy of Sciences

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Intraoperative visualization of morphological patterns of the thoracic duct by subcutaneous inguinal injection of indocyanine green in esophagectomy for esophageal cancer

Tokumaru

Kitazawa

Nakamura

et al. 2022

Annals of Gastroent Surgery

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Chylothorax is a complication that occurs in about 1%-2% of esophagectomies, and it is a refractory complication that can induce pneumonia and sepsis. [1][2][3] Resection of the thoracic duct is considered a risk factor of metastatic recurrence to more organs. 4 On the other hand, Matsuda et al reported that thoracic duct resection during esophagectomy could increase the efficiency of lymph node dissection and improve the prognosis in early esophageal cancer. 5 Either way, intraoperative visualization of the

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Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus

Cited by 65 publications

References 36 publications

Perioperative management and outcomes of minimally invasive esophagectomy: case study of a high-volume tertiary center in Taiwan

Perioperative management and outcomes of minimally invasive esophagectomy: case study of a high-volume tertiary center in Taiwan

Diagnosis, assessment, and management of surgical complications following esophagectomy

Intraoperative visualization of morphological patterns of the thoracic duct by subcutaneous inguinal injection of indocyanine green in esophagectomy for esophageal cancer

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