Management options for post-esophagectomy chylothorax

Fluorescent lymphography for thoracic duct identification: Initial experience of a simplified and feasible ICG administration

“…The first approach to chyle leak is conservative management, consisting in a low‐fat, medium chain triglyceride diet via nasogastric tube/jejunostomoy or total parental nutrition, along with long‐acting somatostatine like octreotide and alpha‐agonists like etilefrine. If no output reduction is observed within 5–7 days (depending on initial output), surgical management through thoracotomy or thoracoscopy must be considered; percutaneous thoracic duct embolisation has lately shown to be a valuable alternative option to surgery 10–12 …”

Non-conservative Management of Chylothorax

“…These anatomic variations are the underlying cause of the diversity of intervention success rates [ 2 , 9 , 11 ]. Moreover, there is a high risk of tearing along the course of the lymphatic pathway during esophagectomy and lymph node dissection due to the proximity of the course of the thoracic duct to other structures [ 1 , 12 , 13 ]. Any tear in the thoracic duct can quickly lead to the accumulation of large volumes of lymphatic fluid, since it usually transports around 2–4 L of chyle per day [ 11 ].…”

“…The appropriate treatment method depends on the etiology and amount of chylothorax. Traditionally, conservative treatment is first administered [ 7 , 9 , 13 - 15 ]. However, in patients with high-volume chylothorax, the timing of appropriate interventions is important.…”

“…Conservative management is considered the first-line modality for all patients with chylothorax [ 7 , 9 , 13 - 15 ].…”

“…during esophagectomy and lymph node dissection due to the proximity of the course of the thoracic duct to other structures [1,12,13]. Any tear in the thoracic duct can quickly lead to the accumulation of large volumes of lymphatic fluid, since it usually transports around 2-4 L of chyle per day [11].…”