Chyle leakage patterns and management after oncologic esophagectomy: A retrospective cohort study

Background: This study aims to evaluate the incidence and characteristics of chyle leakage after curative oncologic esophagectomy, and the effectiveness of thoracic duct ligation. Methods: This is a retrospective cohort study using the medical records of 1514 patients who underwent curative esophagectomy for esophageal cancer between September 1994 and December 2010. Patients whose pleural fluid analysis corresponded to chyle were included, and drainage patterns by different management groups were examined with multilevel models. The chyle leakage patterns during the time before and after duct ligation were also evaluated, adjusting for demographics, clinical characteristics, and treatment. Results: The prevalence of chyle leakage after esophagectomy was 3.8%. The three management groups were as follows: (i) conservative-controlled only with conservative management; (ii) surgical I-duct ligation during the esophagectomy; and (iii) surgical II-duct ligation after the esophagectomy. Pattern analysis determined that drainage of the conservative group was similar to 400 mL/day (maximum on postoperative days [POD] = 9.2); drainage of surgical II was similar to 1000 mL/day (maximum on POD = 18.1). On average, thoracic duct ligation was performed 18.7 days after the esophagectomy, and drainage significantly decreased after duct ligation (P-value <0.001). Conclusions: There was a clear pattern of lower chyle leakage with the patients requiring conservative management compared with those requiring surgical management. Active and prompt surgical management needs to be considered in the early postoperative phase for patients with high-output (over 1000 mL/day) chyle leakage after esophagectomy.