Author of

• 34876

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  P02 - Diagnostics and Interventional Pulmonology (ID 110)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Diagnostics and Interventional Pulmonology
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall

  • 34889

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    P02.11 - Treatment Strategy for Postoperative Chylothorax after Lung Cancer Surgery (ID 868)

    00:00 - 00:00  |  Presenting Author(s): Chihaya Maeda
    • Abstract

    Introduction
    

    Postoperative chylothorax is a relatively rare, but well-known complication after thoracic surgery. Since prolonged chylous leakage will lead to prolonged hospital stay or intrathoracic infection via thoracic drainage tube, appropriate management should be conducted. Our policy has been based on early decision making on surgical intervention, and the aim of this study was to evaluate our treatment strategy.

    Methods
    

    We retrospectively reviewed clinical and pathological data of 737 patients who underwent lobectomy or greater resection with systematic mediastinal lymph node dissection for primary lung cancer at our institution from October 2014 to December 2019. Chylothorax was diagnosed on the basis of chylous leakage from the chest tube and was confirmed by the presence of triglycerides (>110 mg/dL) in the drainage fluid. We initially followed patients with a regular diet and surgical intervention was initiated if the following conditions; A) >500 mL of chylous fluid during the first 24 hours, B) 300-500mL/day but the output was not decreased.If drainage output was 300mL or less in a day (condition C), we performed observational management with serving low fat diet. We fed milk per os preoperatively or in feeding tube intraoperatively in order to detect the site of chylous leakage.

    Results
    

    Postoperative chylothorax was developed in 9 (1.1%) patients of 6 men and 3 women, with a median age of 69 years (range, 54-81). The mode of surgery was lobectomy with lymph node dissections in 8 patients and lymphadenectomy in 1 patient. The histologic type included adenocarcinoma in all patients.Tumor locations in each case were right upper lobe in 3 patients, right middle lobe in 2, right lower lobe in 1, left upper lobe in 1, left lower lobe in 1, and occult tracheal bifurcation lymph node metastasis in 1. A total of 6 patients (conditions A: 3, B: 3, and C: 0) underwent reoperation. In all of the patients who underwent reoperation, leakage points could be identified intraoperatively and ligated. The leakage points were superior mediastinum in 4 patients (right side in 3 patients and left side in 1 patient) and tracheal bifurcation in 2 patients. The median hospital stay after the initial surgery was 8 days (range, 7-12). There were no postoperative complications nor recurrence of chylothorax.

    Conclusion
    

    Our early surgical strategy for postoperative chylothorax resulted in favorable outcomes including short hospital stay in all patients.

    The amount of chylous fluid during regular diet was a goodindicator of early decision making on surgical intervention.