Document Detail


Postesophagectomy chylothorax: incidence, risk factors, and outcomes.
MedLine Citation:
PMID:  22245587     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Chylothorax is a rare but potentially lethal complication of esophagectomy. This study evaluated the rate of postesophagectomy chylothorax, identified associated risk factors, and compared postoperative outcomes in patients with and without chylothorax.
METHODS: We reviewed 892 consecutive patients who underwent esophagectomy (1997 to 2008). Preoperative, operative, and postoperative details, including adverse outcomes and mortality, were analyzed.
RESULTS: Postesophagectomy chylothorax occurred in 34 patients (3.8%). Chylothorax was significantly associated with 30-day major complications (85% vs 46%; p<0.001), including an increased likelihood of sepsis (p=0.001), pneumonia (p=0.009), reintubation (p=0.002) or reoperation (p<0.001), and death (17.7% vs 3.9%, p<0.001). Median length of stay was 17 vs 8 days (p=0.005). Median time to chylothorax diagnosis was 5 days. Thoracic duct ligation was performed in 21 (62%) at a median 13 days after esophagectomy. Two patients required repeat duct ligation for persistent chylothorax. Squamous cell cancer histology (9 of 34; 26%) was an independent predictor of postoperative chylothorax (odds ratio, 4.18; 95% confidence interval, 1.39 to 12.6). Odds of chylothorax were 36 times greater with average daily chest tube output exceeding 400 mL in the first 6 postoperative days (odds ratio, 35.9; 95% confidence interval, 8.2 to 157.8).
CONCLUSIONS: Postoperative chylothorax is associated with significant postoperative morbidity and mortality. Patients with squamous cell cancer may be at increased risk. In addition, average daily chest tube output exceeding 400 mL in the early postoperative period should prompt fluid analysis for chylothorax to facilitate early diagnosis and consideration of thoracic duct ligation.
Authors:
Rachit D Shah; James D Luketich; Matthew J Schuchert; Neil A Christie; Arjun Pennathur; Rodney J Landreneau; Katie S Nason
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-01-15
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  93     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-27     Completed Date:  2012-04-23     Revised Date:  2014-05-12    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  897-903; discussion 903-4     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Chylothorax / epidemiology*,  etiology*,  surgery
Esophagectomy / adverse effects*
Female
Humans
Incidence
Male
Middle Aged
Postoperative Complications / epidemiology
Retrospective Studies
Risk Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K07 CA151613/CA/NCI NIH HHS; UL1 RR024153/RR/NCRR NIH HHS; UL1 RR024153/RR/NCRR NIH HHS
Comments/Corrections
Comment In:
Ann Thorac Surg. 2013 Jan;95(1):387   [PMID:  23272882 ]
Ann Thorac Surg. 2013 Jan;95(1):386-7   [PMID:  23272881 ]

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