Tsuchitani Yuma, Ozawa Yohei, Taniyama Yusuke, Okamoto Hiroshi, Sato Chiaki, Ishida Hirotaka, Kamei Takashi
Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, JPN.
Department of Surgery, Tohoku University Hospital, Sendai, JPN.
Cureus. 2024 Jul 28;16(7):e65606. doi: 10.7759/cureus.65606. eCollection 2024 Jul.
Background Postoperative chylothorax is a rare but life-threatening complication of esophagectomy. However, due to its rarity, researching the risk factors and selecting appropriate treatment options has been limited. Methods This study included 727 patients with esophageal cancer who underwent minimally invasive esophagectomy at our hospital. To detect the risk factors for chylothorax, we divided the patients into two groups, with and without postoperative chylothorax. We then compared patient characteristics, tumor-specific variables, and operative details. Subsequently, we analyzed the peri-treatment characteristics and outcomes for the three distinct treatment options we had chosen: surgery, conversion (the group that finally underwent surgery after unsuccessful conservative treatment), and conservative. Results Of the 727 patients, 18 (2.5%) developed a chylothorax. The mean BMI was lower (20.3 vs. 21.9, p=0.057), and more cases of thoracic duct resection were found in the chylothorax group (33.3% vs. 6.2%, p=0.001), with statistical significance. Multivariate analysis identified thoracic duct resection as a risk factor (adjusted odds ratio, 6.83). The drainage volume two days after chylothorax was higher in the surgery group, although the difference was not statistically significant (surgery group, 1,405 ml vs. conversion group, 260 ml vs. conservative group, 310 ml; p=0.073). The surgery group had the shortest median postoperative hospital days among these groups (21.5 as compared to 102 and 25.0 days in the conversion and conservative groups, respectively; p<0.001). None of the patients died during their hospital stays. Conclusion Thoracic duct resection during the initial minimally invasive esophagectomy was an independent risk factor for chylothorax. If drainage volume does not decrease on the second day, early surgery may lead to earlier discharge.
背景 术后乳糜胸是食管癌切除术罕见但危及生命的并发症。然而，由于其罕见性，对危险因素的研究和合适治疗方案的选择一直有限。方法 本研究纳入了我院727例行微创食管癌切除术的患者。为检测乳糜胸的危险因素，我们将患者分为两组，有和无术后乳糜胸组。然后我们比较了患者特征、肿瘤特异性变量和手术细节。随后，我们分析了我们选择的三种不同治疗方案的围治疗期特征和结局：手术、转换治疗（保守治疗失败后最终接受手术的组）和保守治疗。结果 在727例患者中，18例（2.5%）发生了乳糜胸。乳糜胸组的平均体重指数较低（20.3对21.9，p = 0.057），且乳糜胸组胸导管切除的病例更多（33.3%对6.2%，p = 0.001），具有统计学意义。多因素分析确定胸导管切除为危险因素（调整后的优势比为6.83）。乳糜胸发生两天后的引流量在手术组较高，尽管差异无统计学意义（手术组1405 ml，转换治疗组260 ml，保守治疗组310 ml；p = 0.073）。手术组的术后中位住院天数在这些组中最短（分别为21.5天，而转换治疗组和保守治疗组分别为102天和25.0天；p<0.001）。住院期间无患者死亡。结论 初次微创食管癌切除术中胸导管切除是乳糜胸的独立危险因素。如果第二天引流量未减少，早期手术可能导致更早出院。
