Practical Therapeutic Options for Postoperative Chylothorax

OBJECTIVE An iatrogenic chylothorax following an esophageal or lung resection represents an uncommon complication with a significant morbidity and mortality if not treated promptly. The optimal therapeutic recommendations are not well defined and rely on the results of retrospective clinical series. We reviewed our experience with a consecutive series of patients with major postoperative chylothoraces in addition to published literature to create a rational algorithm for treatment of this frustrating problem. METHODS We conducted a retrospective cohort study of consecutive esophageal and lung resection patients from July 1, 2005 through June 30, 2021, collecting clinical data on all patients who developed a postoperative chylothorax with careful evaluation of the results of definitive therapy. RESULTS Between July 1, 2005 through June 30, 2021, we reviewed clinical data on 17 esophageal resection patients and 51 lung resection patients over a 17-year interval who underwent definitive treatment for their postoperative chylothorax. The esophageal surgery patients ultimately had curative therapy with total parenteral nutrition (TPN) (18%), medium chain triglyceride (MCT) enteral tube diet(18%), and in performing a surgical ligation of the thoracic duct(35%). For the lung surgery patients, the most effective treatments were octreotide/midodrine(29%), surgical ligation of the thoracic duct(23%) and the performance of a lymphangiogram with embolization or combined with octreotide(15%). CONCLUSIONS All patients in our cohort of esophageal and lung resection patients had curative therapy of the chylothorax with aggressive, invasive procedures mostly directed toward interruption or ligation of the thoracic duct while some patients responded well to dietary and drug therapy.