Chylothorax following oesophagogastrectomy for malignant disease

Objective: To define the incidence, causes, management and impact of Chylot horax after oesophagogastrectomy for malignant disease in Nottingham Thorac ic Surgery unit. Patients and methods: Retrospective analysis of 523 patien ts with cancer of the oesophagus or the gastro-oesophageal junction who und erwent oesophageal resection between January 1987 and November 1997 in a si ngle unit using similar techniques and uniform routine perioperative manage ment. Results: Chylothorax occurred in 21 patients (4.0%). There were 12 ma les and 9 females with a mean age of 64.7 years (SD 7.5). Age, sex, tumour site, length, histological type, depth of wall penetration, nodal status an d type of operative approach were not significant predisposing factors on u nivariate and multivariate analysis. Seventeen patients were treated conser vatively (four deaths, 23.5%) and four surgically (one death, 25.0%), effec tive control of the chylous leak being achieved in all four cases. Eleven p atients with a chylous drainage of up to 2.2 l/day, diminishing within 1 we ek of conservative treatment had an uneventful recovery. However, a chylous drainage of more than 2.5 l/day in the remaining ten patients was associat ed with increased morbidity, hospital stay, operative mortality and the nee d for surgical intervention. In comparison with the remaining patients (n = 502), those who developed chylothorax (n = 21) had more respiratory compli cations (42.8%, P = 0.008), longer mean hospital stay (23.8 days, P = 0.004 ), higher operative mortality (23.1%, P = 0.001) and, unexpectedly, reduced 5 year survival rate (P < 0.0001). Conclusions: Then appeared to be no cle ar predisposing factor in the development of a chylous leak other than the routine extensive dissection. Although definitive conclusions can not be dr awn, where there is early reduction of the initial amount (in this series u p to 2.2 l/day) of drainage, there may be a place for successful non-surgic al management; in cases of high output chylothorax, persisting after a few days of conservative treatment, however, early re-operation and ligation of the thoracic duct, seems to be advisable. (C) 1998 Elsevier Science B.V. A ll rights reserved.