Chylothorax after oesophagectomy
Chylothorax is an uncommon complication of oesophagectomy. in a review of 537 oesophageal resections there were I 1 cases of chylothorax, an incidence of 2.0 per cent. There was no correlation with site, size, penetration, lymph node status, length or type of tumour but there was u significant correlation between chylothorax and the type of operative procedure carried out. The incidence in 9. 5 transhiatal resections was 10.5 per cent. The incidence following 442 transthoracic procedures was 0.2 per cent (P<O.OOI) with one chylous fistula occurring ajter a three-stage oesophagectomy. Initial management was conservative with chest drainage and total parenteral nutrition. Thoracotomy and duct ligation was subsequently carried out in three patients and was successful in two. The third patient died. Conservative management alone was successful in four out of eight patients, with closure of the fistula at a median of 35 days (range 14-42 days). Four patients treated conservatively died. Transhiatal oesohagectomy greatly increases the risk of chylothovux, a condition that carries a high mortality rate (46per cent in this series) whether managed conservatively or by surgical intervention.
Chylothorax may result from congenital atresia of the thoracic duct. carcinomatous infiltration, malposition of a subclavian line or blunt chest trauma, but thoracic surgical procedures account for the majority ofcases in adults'. While it has hitherto been considered an uncommon complication of oesophageal resection',' a recent report has suggested that chylothorax is increasing in incidence'. The aims of this study were to examine the factors that might predispose to the development of chylothorax and to review management of the condition.