Thoracic duct injury during esophagectomy: 20 years experience at a tertiary care center in a developing country

Abstract

Thoracic duct injury is an uncommon complication of esophagectomy. Experience in managing these cases is limited to large centers performing esophagectomies in good numbers. We analyzed the prospectively maintained esophageal diseases database of patients presenting to a surgical unit between 1982 and 2002. Among 552 esophagectomies during this period we had encountered 14 cases of chylothorax (2.54%). We analyzed the type and site of lesion and the impact of neoadjuvant therapy on the incidence of thoracic duct injury. Among 459 patients of transhiatal esophagectomy, 11 developed postoperative chylothorax (2.40%). In 93 transthoracic resections, there were three cases of chylothorax (3.23%; (P = 0.9185)). The incidence following preoperative radiotherapy was 2.17%. None of the 31 patients, who had undergone esophagectomy for benign diseases had developed chylothorax. In the carcinoma group the incidence in middle third lesions was 5.85% and in lower third lesions was 0.80% (P = 0.0018). Seven patients were managed conservatively. Two of these patients, for whom surgery had been planned, died before they could be taken up for surgery. In the remaining seven patients transthoracic ligation of the thoracic duct was performed. Two patients in this group died. The average hospital stay was 20 days in the conservative group and 12 days in the surgery group. Among the factors studied, patients with middle third lesions were at increased risk of developing postoperative chylothorax, when compared to upper or lower third lesions.

Localization of thoracic duct using heavily T2W MRI for intractable post-esophagectomy chylothorax—a case report

“…A similar finding was reported by Rao et al who found that the incidence of chylothorax in middle-third lesions was relatively higher than that in lower-third lesions (14). Thus, it is believed that the thoracic duct is in close proximity to the middle third of the thoracic esophagus, thus making it prone to injury during mediastinal dissection despite the surgeon's vigilance.…”

Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer

“…As for the increasing incidence for postoperative chylothorax after video-assisted thoracoscopic esophagectomy in our series, we presumed that the more keen-dissection during esophageal resection might be the potential reason. Although there is no conclusive data available regarding the indication and time point of surgical ligation of the thoracic duct, many authors still recommend early surgical ligation of the thoracic duct for minimizing the risk of mortality [3,8,12,21,22]. In our series, there were eight total patients who developed a chylothorax after videoassisted thoracoscopic esophagectomy.…”

Comparison of Early and Late Complications in Three Esophagectomy Techniques

“…Chylothorax after esophagectomy is a rare but potentially fatal complication which have been reported 0.4% -4% (33,34).…”

“…If chyle is not stopped, patients will faced immune deficiency, resulting in infection and mortality (35). Some studies have shown the superiority of surgery over conservative treatment (34,(38)(39)(40). Thus, the treatment method of Chylothorax is conservative but when the outlet of the chest tube is more than 800 cc per day and it will continue for 4 to 5 consecutive days, waiting for stopping the leak may be dangerous due to leukopenia and malnutrition; therefore, surgery is required in these circumstances.…”