OUTPUT OF CHYLE AS AN INDICATOR OF TREATMENT FOR CHYLOTHORAX COMPLICATING ESOPHAGECTOMY

Background The management of chylothorax complicating oesophagectomy r emains controversial. Even if medical management alone can be successf ul, some authors advocate early reoperation. The aim of this retrospec tive study was to identify the clinical variables associated with a hi gh probability of full recovery with medical treatment. Methods Among 850 Lewis procedures performed for oesophageal carcinoma, 23 patients (2.7 per cent) developed postoperative chylothorax despite systematic preventive ligation of the main thoracic duct. Patients who responded to conservative management were compared with those requiring reoperat ion for preoperative radiotherapy, unilateral versus bilateral pleural effusion, delay of occurrence of the chylothorax, and ratio of mean c hylous output to body-weight 1 and 5 days after its onset. Results Con servative management was successful in 14 patients with a mean(s.d.) d elay of 12(5) (range 7-21) days and there were no hospital deaths. Reo peration was necessary in nine patients; there were two postoperative deaths and no recurrence of the chylothorax. The only significant diff erence between reoperated and medically treated patients was the mean( s.d.) chylous output at day 5: 23 5(16.6) versus 6.7(5.5) mi per kg bo dy-weight (P < 0.001). At this time, the output was less than 10 ml/kg in 12 of 14 patients in whom medical treatment was successful (sensit ivity 86 per cent), and equal to or greater than this cut-off value in all the patients who underwent reoperation (specificity 100 per cent) . Conclusion The ratio of chylous output to body-weight on the fifth d ay after the onset of a chylothorax complicating oesophagectomy seems to reliably predict the success of continuing medical treatment.