Malibary Nadim, Manfredelli Simone, Almuttawa Abdullah, Delhorme John-Baptiste, Romain Benoit, Brigand Cecile, Rohr Serge
Surgery, King Abdulaziz University, Jeddah, SAU.
Visceral and General Surgery, Hautepierre Hospital, Strasbourg, FRA.
Cureus. 2020 Jun 19;12(6):e8696. doi: 10.7759/cureus.8696.
Chylothorax (CHT) is a known post-operative complication after esophageal surgery with vaguely defined risk factors.
This is a retrospective chart review of 70 consecutive patients with operable cancer over a period of four years (January 2013 to December 2016). Ivor Lewis and McKeown interventions were performed. Thoracic duct is identified and ligated routinely. Factors related to the patient, the tumor, and the operating surgeon were analyzed.
Incidence of CHT was 10%. Surgeons with less than five years of esophageal surgery experience had the most CHT, 71% (p=0.001). No association was found between tumor location, type, body mass index (BMI), neoadjuvant therapy, response to neoadjuvant therapy or male sex, and CHT. The odds of developing CHT were 17 times higher in patients operated by a junior surgeon (odds ratio, OR=17.67, confidence interval, CI 2.68-116.34, p=0.003). Four patients (5.7%) had anastomotic leaks, none of them had CHT. Senior surgeons had less operative time and harvested more lymph nodes (p=0.0002 and p=0.1086 respectively).
Surgeon's experience might be considered a major risk factor to develop CHT. This finding needs to be confirmed by a larger multicentric series taking into consideration the human factor.
乳糜胸是食管手术后已知的一种术后并发症，其危险因素尚不明确。
这是一项对70例连续可手术癌症患者进行的回顾性病历审查，研究时间跨度为四年（2013年1月至2016年12月）。采用了艾弗·刘易斯（Ivor Lewis）和麦基翁（McKeown）手术方式。常规识别并结扎胸导管。对与患者、肿瘤及手术医生相关的因素进行了分析。
乳糜胸的发生率为10%。食管手术经验少于五年的外科医生所治疗的患者中乳糜胸发生率最高，为71%（p = 0.001）。未发现肿瘤位置、类型、体重指数（BMI）、新辅助治疗、对新辅助治疗的反应或男性性别与乳糜胸之间存在关联。由初级外科医生进行手术的患者发生乳糜胸的几率高出17倍（优势比，OR = 17.67，置信区间，CI 2.68 - 116.34，p = 0.003）。4例患者（5.7%）发生吻合口漏，其中无一例发生乳糜胸。资深外科医生的手术时间更短，清扫的淋巴结更多（分别为p = 0.0002和p = 0.1086）。
外科医生的经验可能被视为发生乳糜胸的一个主要危险因素。这一发现需要通过考虑人为因素的更大规模多中心系列研究来证实。
