Use of Octreotide for the Management of Chyle Fistula Following Neck Dissection

Abstract

In these patients, octreotide was safe and effective in resolving neck chylous fistulas. Octreotide therapy appears superior to traditional conservative measures of diet restriction and pressure dressings when compared with literature rates. A prospective study is needed to confirm results, but octreotide therapy should be considered as first-line conservative management for neck chyle fistulas that occur after neck surgery.

Pseudomonas aeruginosa‐mannose sensitive hemagglutinin injection therapy for the treatment of chyle fistula following neck dissection

“…The results showed that eight (80%) of 10 patients in low‐output group and four (25%) of 16 patients in high‐output group got resolution of chyle fistula by octreotide therapy in combination with other conservative management. However, the overall success rate of conservative therapy was 46.2% (12/26), which was considerably lower than that described in previous studies (reported range, 80%‐100%) . This may have been due to the high‐output cases with a higher proportion in this study.…”

“…This may have been due to the high‐output cases with a higher proportion in this study. Sixty‐two percent of patients (16/26) had high‐output chyle fistula (>500 mL), while the proportion of high‐output cases in previous studies was 33.3% (4/12), 21.1% (4/19), and 20.0% (2/10), respectively . Therefore, our findings in the present study suggest that octreotide therapy may have a limited effect on high‐output leakage.…”

“…Chyle fistula following neck dissection is rare, and the incidence varies depending on surgical extent . Most reported cases involve lateral neck dissection (radical or selective), but can develop following central neck dissection . Previous studies have reported chyle fistula with an incidence of 3.9% to 8.3% after lateral neck dissection .…”

“…Among them, diet modification consisted of a fat‐free diet, a low‐fat diet, a medium‐chain triglyceride diet, or TPN is the important part of conservative treatment. These measures aim to promote spontaneous fistula closure by reducing chyle production and flow . Intravenous infusion or subcutaneous injection of somatostatin or its long‐acting analogue, octreotide, has been reportedly effective in treating chyle fistula after neck dissection in several studies .…”

“…These measures aim to promote spontaneous fistula closure by reducing chyle production and flow . Intravenous infusion or subcutaneous injection of somatostatin or its long‐acting analogue, octreotide, has been reportedly effective in treating chyle fistula after neck dissection in several studies . The main mechanism of octreotide is to directly act on vascular somatostatin receptors to minimize the endocrine and exocrine secretions of the pancreas, intestine, and gallbladder, as well as to reduce chyle production by inhibiting nutrient absorption through the alimentary tract .…”