Amsterdam UMC, location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, The Netherlands.
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
Dis Esophagus. 2023 Jan 28;36(2). doi: 10.1093/dote/doac047.
The clinical consequences of chyle leakage following esophagectomy are underexposed. The aim of this study was to investigate the clinical implications of chyle leakage following esophagectomy. This retrospective study of prospectively collected data included patients who underwent transthoracic esophagectomy in 2017-2020. Routinely, the thoracic duct was resected en bloc as part of the mediastinal lymphadenectomy. Chyle leakage was defined as milky drain fluid for which specific treatment was initiated and/or a triglyceride level in drain fluid of ≥1.13 mmol/L, according to the Esophagectomy Complications Consensus Group (ECCG) classification. Primary endpoints were the clinical characteristics of chyle leakage (type, severity and treatment). Secondary endpoints were the impact of chyle leakage on duration of thoracic drainage and hospital stay. Chyle leakage was present in 43/314 patients (14%), of whom 24 (56%) were classified as severity A and 19 (44%) as severity B. All patients were successfully treated with either medium chain triglyceride diet (98%) or total parental nutrition (2%). There were no re-interventions for chyle leakage during initial admission, although one patient needed additional pleural drainage during readmission. Patients with chyle leakage had 3 days longer duration of thoracic drainage (bias corrected accelerated (BCa) 95%CI:0.46-0.76) and 3 days longer hospital stay (BCa 95%CI:0.07-0.36), independently of the presence of other complications. Chyle leakage is a relatively frequent complication following esophagectomy. Postoperative chyle leakage was associated with a significant longer duration of thoracic drainage and hospital admission. Nonsurgical treatment was successful in all patients with chyle leakage.
胸导管结扎术在食管癌切除术后的临床后果被低估了。本研究旨在探讨食管癌切除术后乳糜漏的临床意义。这项前瞻性收集数据的回顾性研究纳入了 2017 年至 2020 年接受经胸食管切除术的患者。常规情况下，胸导管作为纵隔淋巴结清扫术的一部分整块切除。乳糜漏的定义为开始进行特定治疗的乳白色引流液，或引流液中的甘油三酯水平≥1.13mmol/L，根据食管癌并发症共识组（ECCG）分类。主要终点是乳糜漏的临床特征（类型、严重程度和治疗）。次要终点是乳糜漏对胸腔引流和住院时间的影响。314 例患者中有 43 例（14%）发生乳糜漏，其中 24 例（56%）为 A 级严重程度，19 例（44%）为 B 级严重程度。所有患者均成功接受中链甘油三酯饮食（98%）或全胃肠外营养（2%）治疗。尽管有 1 例患者在再次入院时需要额外的胸腔引流，但在初次入院期间没有因乳糜漏进行再次干预。乳糜漏患者的胸腔引流时间延长 3 天（校正后加速（BCa）95%CI：0.46-0.76），住院时间延长 3 天（BCa 95%CI：0.07-0.36），与其他并发症的存在无关。乳糜漏是食管癌切除术后相对常见的并发症。术后乳糜漏与胸腔引流和住院时间显著延长有关。所有乳糜漏患者均通过非手术治疗成功治愈。
