Fujita Takeo, Daiko Hiroyuki
Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-0882, Japan,
World J Surg. 2014 Aug;38(8):2039-45. doi: 10.1007/s00268-014-2501-7.
Postoperative chylothorax sometimes follows thoracic esophagectomy for esophageal cancer. The effectiveness of octreotide treatment for it and factors that predict its response are unclear. This study aimed to evaluate the efficacy of octreotide for treating postoperative chylothorax following thoracic esophagectomy for esophageal cancer and factors that might predict successful treatment and allow chest drain removal.
We assessed 521 consecutive patients who underwent thoracic esophagectomy for esophageal cancer to investigate the efficacy of octreotide for postoperative chylothorax. Among those with postoperative chylothorax, one group (group A) underwent conservative management, and the other (group B) was treated conservatively with added octreotide administration. We evaluated the clinical outcomes after octreotide administration and assessed the factors associated with successful treatment.
Among the 521 patients, 20 (3.8%) developed postoperative chylothorax: five in group A and 15 in group B. Two of the five (20%) group A patients and 13 of the 15 (86.6%) group B patients were treated successfully (p = 0.03). Factors significantly associated with treatment failure were (1) chest drain output of >1,000 ml/day before treatment (p = 0.04); (2) no reduction in chest drainage by the second day of treatment (p = 0.016); (3) chest drainage of >1,000 ml/day through the second day of treatment (p = 0.006).
For patients with esophageal cancer who undergo thoracic esophagectomy, octreotide can be an effective treatment for postoperative chylothorax.
食管癌胸段食管切除术后有时会发生乳糜胸。奥曲肽治疗乳糜胸的有效性以及预测其疗效的因素尚不清楚。本研究旨在评估奥曲肽治疗食管癌胸段食管切除术后乳糜胸的疗效，以及可能预测治疗成功并允许拔除胸腔引流管的因素。
我们评估了521例连续接受食管癌胸段食管切除术的患者，以研究奥曲肽治疗术后乳糜胸的疗效。在术后发生乳糜胸的患者中，一组（A组）接受保守治疗，另一组（B组）在保守治疗的基础上加用奥曲肽。我们评估了奥曲肽给药后的临床结局，并评估了与治疗成功相关的因素。
在521例患者中，20例（3.8%）发生了术后乳糜胸：A组5例，B组15例。A组5例患者中有2例（20%）治疗成功，B组15例患者中有13例（86.6%）治疗成功（p = 0.03）。与治疗失败显著相关的因素为：（1）治疗前胸腔引流量>1000 ml/天（p = 0.04）；（2）治疗第2天胸腔引流量未减少（p = 0.016）；（3）至治疗第2天胸腔引流量>1000 ml/天（p = 0.006）。
对于接受胸段食管切除术的食管癌患者，奥曲肽可作为术后乳糜胸的有效治疗方法。
