1
|
Krivonosov AA, Minnullin MM, Akhaladze DG, Grachev NS. [Surgery for abdominal neuroblastoma in children]. Khirurgiia (Mosk) 2024:152-160. [PMID: 38785252 DOI: 10.17116/hirurgia2024051152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
This review is devoted to surgical approach for neurogenic tumors in children. The authors discuss epidemiological data, history of surgical approaches, preoperative imaging and risk factors. A special attention is paid to the influence of surgical interventions for various neuroblastomas on overall and event-free survival in pediatric population, as well as the most common surgical complications and modern approaches to their treatment.
Collapse
Affiliation(s)
- A A Krivonosov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - M M Minnullin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - D G Akhaladze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - N S Grachev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| |
Collapse
|
2
|
Pieper CC, Geiger S, Kupczyk P, Luetkens JA, Köster T, Attenberger UI, Schild HH. Post-interventional infectious complications in percutaneous transabdominal lymphatic interventions: an observational study. Sci Rep 2023; 13:17643. [PMID: 37848443 PMCID: PMC10582110 DOI: 10.1038/s41598-023-42197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 09/06/2023] [Indexed: 10/19/2023] Open
Abstract
The purpose of this retrospective study was to evaluate the occurrence of infectious complications and inflammatory reactions after transabdominal lymphatic-interventions. 63 lymphatic-interventions were performed in 60 patients (male/female: 35/25; mean age 56 [9-85] years) [chylothorax n = 48, chylous ascites n = 7, combined chylothorax/chylous ascites n = 5]. Post-interventional clinical course and laboratory findings were analyzed in the whole cohort as well as subgroups without (group A; n = 35) and with peri-interventional antibiotics (group B; n = 25) (pneumonia n = 16, drainage-catheter inflammation n = 5, colitis n = 1, cystitis n = 1, transcolonic-access n = 2). No septic complications associated with the intervention occurred. Leucocytes increased significantly, peaking on post-interventional day-1 (8.6 ± 3.9 × 106 cells/mL vs. 9.8 ± 4.7 × 106 cells/mL; p = 0.009) and decreased thereafter (day-10: 7.3 ± 2.7 × 106 cells/mL, p = 0.005). CRP-values were pathological in 89.5% of patients already at baseline (40.1 ± 63.9 mg/L) and increased significant on day-3 (77.0 ± 78.8 mg/L, p < 0.001). Values decreased thereafter (day-15: 25.3 ± 34.4 mg/L, p = 0.04). In subgroup B, 13/25 patients had febrile episodes post-interventionally (pneumonia n = 11, cystitis n = 1, drainage-catheter inflammation n = 1). One patient developed biliary peritonitis despite continued antibiotics and underwent cholecystectomy. Baseline leucocytes and CRP-levels were higher in group B than A, but with comparable post-interventional profiles. Clinically relevant infectious complications associated with transabdominal lymphatic-interventions are rare irrespective of peri-interventional antibiotic use. Post-interventional elevation of leucocytes and CRP are observed with normalization over 10-15 days.
Collapse
Affiliation(s)
- Claus Christian Pieper
- Division for Minimally-invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany.
- Department of Radiology, University of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany.
| | - Sergej Geiger
- Division for Minimally-invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| | - Patrick Kupczyk
- Division for Minimally-invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| | - Julian A Luetkens
- Division for Minimally-invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| | - Thomas Köster
- Division for Minimally-invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| | - Ulrike I Attenberger
- Division for Minimally-invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| | - Hans Heinz Schild
- Division for Minimally-invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
| |
Collapse
|
3
|
Kaminski LC, Wagenpfeil J, Buermann J, Lutz PL, Luetkens JA, Attenberger UI, Strassburg CP, Kalff JC, Schild HH, Pieper CC. Long-Term Clinical Outcome of Abdomino-Thoracic Lymphatic Interventions of Traumatic and Non-Traumatic Lymphatic Leakage in Adults. Biomedicines 2023; 11:2556. [PMID: 37760997 PMCID: PMC10526188 DOI: 10.3390/biomedicines11092556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/02/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this study was to retrospectively evaluate the long-term results of lymphatic interventions in adults with abdomino-thoracic lymphatic pathologies. Management of abdomino-thoracic chylous effusions in adults undergoing X-ray-lymphangiography with or without lymph-vessel embolization (LVE) from 2010-2018 was reviewed. Patients underwent lymphangiography alone when imaging showed normal findings or lymphatic obstruction without leakage or reflux; otherwise, LVE was performed (leakage, reflux, obstruction with leakage or reflux, lymphatic masses). Technical and clinical success, complications, and long-term outcomes were assessed. 78 patients (47 male, median age 56.3 years) were treated for chylous effusions (60.3% traumatic, 39.7% non-traumatic). Lymphangiography showed leakage (48.7%), reflux (14.1%), obstruction (28.2%), lymphatic masses (5.1%), and normal findings (3.8%). Embolization was performed in 49/78 (62.8%) cases. Overall, treatment was clinically successful in 74.4% (mean follow-up of 28 months), with significant differences between LVE and lymphangiography (91.8% vs. 44.8%; p < 0.001), traumatic and non-traumatic etiologies (89.4% vs. 51.6%; p < 0.001), and leakage locations (p = 0.003). The clinical success of LVE did not differ between leakage etiologies or locations. Complications occurred in 5 patients (2/5 needed treatment). Patients survived significantly longer after successful treatment (2679 vs. 927 days; p = 0.044) and without malignancy (3214 vs. 1550 days; p = 0.043). Lymphatic interventions are safe and effective. LVE should be attempted whenever feasible, as success is high (>90%). Successful intervention has a positive effect on patient survival.
Collapse
Affiliation(s)
- Lea C. Kaminski
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| | - Julia Wagenpfeil
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| | - Jens Buermann
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Philipp L. Lutz
- Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany
| | - Julian A. Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| | - Ulrike I. Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| | | | - Jörg C. Kalff
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, 53127 Bonn, Germany
| | - Hans H. Schild
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| | - Claus C. Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital of Bonn, 53127 Bonn, Germany (H.H.S.)
| |
Collapse
|
4
|
Pieper CC. Back to the Future II-A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions. Invest Radiol 2023; 58:610-640. [PMID: 37058335 DOI: 10.1097/rli.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
ABSTRACT Lymphatic imaging and interventional therapies of disorders affecting the lymphatic vascular system have evolved rapidly in recent years. Although x-ray lymphangiography had been all but replaced by the advent of cross-sectional imaging and the scientific focus shifted to lymph node imaging (eg, for detection of metastatic disease), interest in lymph vessel imaging was rekindled by the introduction of lymphatic interventional treatments in the late 1990s. Although x-ray lymphangiography is still the mainstay imaging technique to guide interventional procedures, several other, often less invasive, techniques have been developed more recently to evaluate the lymphatic vascular system and associated pathologies. Especially the introduction of magnetic resonance, and even more recently computed tomography, lymphangiography with water-soluble iodinated contrast agent has furthered our understanding of complex pathophysiological backgrounds of lymphatic diseases. This has led to an improvement of treatment approaches, especially of nontraumatic disorders caused by lymphatic flow abnormalities including plastic bronchitis, protein-losing enteropathy, and nontraumatic chylolymphatic leakages. The therapeutic armamentarium has also constantly grown and diversified in recent years with the introduction of more complex catheter-based and interstitial embolization techniques, lymph vessel stenting, lymphovenous anastomoses, as well as (targeted) medical treatment options. The aim of this article is to review the relevant spectrum of lymphatic disorders with currently available radiological imaging and interventional techniques, as well as the application of these methods in specific, individual clinical situations.
Collapse
Affiliation(s)
- Claus C Pieper
- From the Division for Minimally Invasive Lymphatic Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn; and Center for Rare Congenital Lymphatic Diseases, Center of Rare Diseases Bonn, Bonn, Germany
| |
Collapse
|
5
|
Wang K, Xiao J, Li L, Li X, Yang Y, Liu Z, Jiang J. The application of a medium-chain fatty diet and enteral nutrition in post-operative chylous leakage: analysis of 63 patients. Front Nutr 2023; 10:1128864. [PMID: 37545584 PMCID: PMC10399236 DOI: 10.3389/fnut.2023.1128864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background Post-operative chylous leakage (CL) is the pathologic leakage of chylomicron fluid after surgery. This retrospective study was performed to evaluate a uniform oral nutrition management strategy on the post-operative CL. Methods We retrospectively reviewed patients who developed post-operative CL and received consultation from a clinical nutritionist in seven departments of the Second Affiliated Hospital of Dalian Medical University from May 2020 to April 2022. We designed the oral nutrition intervention program which mainly standardized the type and amount of foods contained in the medium-chain triglyceride (MCT) diet. The influencing factors of curative efficacy were analyzed. Finally, binary logistic regression analysis was conducted to observe the relationship between curative efficacy and potentially predictive variables, including post-operative albumin, post-operative hemoglobin, surgical procedure, and drainage volume at consultation. Results Sixty-three patients with post-operative CL were included in this analysis. Of this number, 58 patients were cured successfully without other treatments. Three patients had a significantly prolonged recovery period, and the remaining two cases were treated by reoperation therapy. The leakage volume at the initiation of enteral intervention had no statistically significant difference in seven surgical departments and surgical sites (left, right, median, and bilateral). The length of stay (LOS) of patients with CL after the intervention was not significantly increased in cardiac, hepatobiliary, gastrointestinal, and urological surgeries. Patients with CL had longer LOS than those without CL in gynecology (P=0.044) and thyroid surgery departments (P=0.008). Each unit increase in post-operative hemoglobin would increase the probability of an effective outcome by 8%, which was statistically significant (P = 0.037). Conclusion In treating patients with post-operative CL, we recommend the MCT diet and EN as the first option, rather than fasting, parenteral nutrition (PN), or octreotide.
Collapse
Affiliation(s)
- Ke Wang
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jiaming Xiao
- Department of Nutrition and Food Hygiene, School of Public Health, Dalian Medical University, Dalian, Liaoning, China
| | - Li Li
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xu Li
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yilun Yang
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zhiyu Liu
- Department of Urological Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jing Jiang
- Department of Nursing, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| |
Collapse
|
6
|
Bauer C, Dori Y, Scala M, Tulzer A, Tulzer G. Current diagnostic and therapeutic strategies for the management of lymphatic insufficiency in patients with hypoplastic left heart syndrome. Front Pediatr 2023; 11:1058567. [PMID: 36911024 PMCID: PMC9999027 DOI: 10.3389/fped.2023.1058567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/31/2023] [Indexed: 03/14/2023] Open
Abstract
Children with hypoplastic left heart syndrome share unique hemodynamic features that alter lymphatic integrity at all stages of palliation. Lymphatic congestion is almost universal in this patient group to some extent. It may lead to reversal of lymphatic flow, the development of abnormal lymphatic channels and ultimately decompression and loss of protein rich lymphatic fluid into extra lymphatic compartments in prone individuals. Some of the most devastating complications that are associated with single ventricle physiology, notably plastic bronchitis and protein losing enteropathy, have now been proven to be lymphatic in origin. Based on the new pathophysiologic concept new diagnostic and therapeutic strategies have recently been developed. Dynamic contrast magnetic resonance lymphangiography is now mainstay in diagnosis of lymphatic insufficiency and allows a thorough assessment of anatomy and function of the main lymphatic compartments through intranodal, intrahepatic and intramesenteric lymphatic imaging. Contrast enhanced ultrasound can evaluate thoracic duct patency and conventional fluoroscopic lymphangiography has been refined for evaluation of patients where magnetic resonance imaging cannot be performed. Novel lymphatic interventional techniques, such as thoracic duct embolization, selective lymphatic duct embolization and liver lymphatic embolization allow to seal abnormal lymphatic networks minimally invasive and have shown to resolve symptoms. Innominate vein turn-down procedures, whether surgical or interventional, have been designed to reduce lymphatic afterload and increase systemic preload effectively in the failing Fontan circulation. Outflow obstruction can now be managed with new microsurgical techniques that create lympho-venous anastomosis. Short term results for all of these new approaches are overall promising but evidence is sparse and long-term outcome still has to be defined. This review article aims to summarize current concepts of lymphatic flow disorders in single ventricle patients, discuss new emerging diagnostic and therapeutic strategies and point out lacks in evidence and needs for further research on this rapidly growing topic.
Collapse
Affiliation(s)
- Christoph Bauer
- Department of Paediatric Cardiology, Kepler University Hospital GmbH, Linz, Austria.,Johannes Kepler University Linz, Linz, Austria
| | - Yoav Dori
- Department of Cardiology, Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Mario Scala
- Johannes Kepler University Linz, Linz, Austria.,Central Radiology Institute, Kepler University Hospital GmbH, Linz, Austria
| | - Andreas Tulzer
- Department of Paediatric Cardiology, Kepler University Hospital GmbH, Linz, Austria.,Johannes Kepler University Linz, Linz, Austria
| | - Gerald Tulzer
- Department of Paediatric Cardiology, Kepler University Hospital GmbH, Linz, Austria.,Johannes Kepler University Linz, Linz, Austria
| |
Collapse
|
7
|
Nandy K, Jayaprakash D, Rai S, Kumar A, Puj K, Tripathi U. Management of Chyle Leak After Head and Neck Surgery; Our Meritorious Experience in 52 Cases and Review of Literature. Indian J Otolaryngol Head Neck Surg 2022; 74:5978-5983. [PMID: 36742724 PMCID: PMC9895173 DOI: 10.1007/s12070-021-02648-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023] Open
Abstract
Iatrogenic chyle leak is commonly seen when dissection happens very low in neck. Management of chyle leak is conservative with compression dressing, fat restricted diet, somatostatin analogues. Surgery is required in extreme cases with failure of conservative treatment. This is a retrospective observational study carried out from a prospectively maintained database. A total of 6482 head and neck surgeries with neck dissections were carried out between January 2015 till July 2020 at our tertiary cancer center. Out of which there were 52 cases of chyle leak reported post neck dissection. All details regarding age, sex, primary tumor location, surgery performed, level of nodal dissection performed, details related to chyle leak from beginning day and its progression and management offered. The median age in the study group was 42 years (24-70 years). Chyle leak was most commonly seen on left side (88.5%). Low output leaks(n = 43) resolved within a median period of 9 days (5-13 days) period of conservative management. High output leak (n = 9) had leak resolution within a median period of 12 days (7-19 days). Patients who had received preoperative radiotherapy and who had extra nodal extension in lymph nodes had significantly higher incidence of high output leaks. Chyle leak is a rare but serious complication in head and neck surgery. Timely identification and management is crucial. Conservative management is mainstay. Surgical management is instituted in cases of failure of conservative management.
Collapse
Affiliation(s)
- Kunal Nandy
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Dipin Jayaprakash
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Shreya Rai
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Ajay Kumar
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Ketul Puj
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad, Gujarat 380016 India
| | - Umank Tripathi
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Asarwa, Ahmedabad, Gujarat 380016 India
| |
Collapse
|
8
|
Kariya S, Yamamoto S, Nakatani M, Ono Y, Maruyama T, Tanigawa N. The role of lymphatic interventional radiology for postoperative lymphorrhea. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Shuji Kariya
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | | | - Miyuki Nakatani
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Yasuyuki Ono
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Takuji Maruyama
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, Osaka, Japan
| |
Collapse
|
9
|
Management of lymphoma-associated chylothorax by interventional radiology and chemotherapy: a report of five cases. Int J Hematol 2022; 116:579-585. [PMID: 35819710 DOI: 10.1007/s12185-022-03397-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 10/17/2022]
Abstract
Chylous effusion is associated with lymphatic obstruction or leakage in mediastinal or abdominal lymph nodes, and is a rare but troublesome complication in patients with malignant lymphomas. Although there is no standard of care, it is often treated with simultaneous chemotherapeutic and non-chemotherapeutic interventions. Here, we describe the cases of five patients with lymphoma-associated chylothorax with the aim of clarifying an effective treatment strategy. All patients achieved a partial response or better for lymphoma. All patients underwent interventional radiology (IVR) procedures, including lymphangiography (LAG) and thoracic duct embolization (TDE). Complete resolution of chylothorax was eventually achieved by IVR procedures or pleurodesis in all patients. No patients experienced serious adverse events related to LAG/TDE. Treatment of chylous effusion required months for most patients (range: 0.2-4.8 months). Our data suggest that a combination of chemotherapy and LAG/TDE is effective for refractory lymphoma-related chylous effusion.
Collapse
|
10
|
Lymphatic Interventions in the Cancer Patient. Curr Oncol Rep 2022; 24:1351-1361. [PMID: 35639331 DOI: 10.1007/s11912-022-01293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The incidence of lymphatic leakage (iatrogenic and non-iatrogenic) is growing in cancer population due to the increased complexity of the surgical procedures and improved overall survival in cancer patients. The purpose of this article is to review the contemporary approach in the field of percutaneous lymphatic embolization in cancer patients with lymphatic leaks. RECENT FINDINGS Since the advent of intranodal lymphangiography in 2011 alongside with the MR and CT lymphangiography, the accuracy of diagnosis of the lymphatic diseases has significantly improved significantly. These advancements have triggered a revival of minimally invasive lymphatic interventions. Lymphatic embolization is expanding from the classic indication, thoracic duct embolization, to other lymphatic disorders (chylous ascites, lymphoceles, liver lymphorrhea, protein-losing enteropathy). The growth of lymphatic research and the standardization of the lymphatic interventions require a multidisciplinary and collaborative approach between physicians and researchers.
Collapse
|
11
|
Power R, Smyth P, Donlon NE, Nugent T, Donohoe CL, Reynolds JV. Management of chyle leaks following esophageal resection: a systematic review. Dis Esophagus 2021; 34:doab012. [PMID: 33723611 PMCID: PMC8597908 DOI: 10.1093/dote/doab012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chyle leakage is an uncommon but potentially life-threatening complication following esophageal resections. The optimal management strategy is not clear, with a limited evidence base. METHODS Searches were conducted up to 31 December 2020 on MEDLINE, Embase, and Web of Science for randomized trials or retrospective studies that evaluated the management of chyle leakage following esophageal resection. Two authors independently screened studies, extracted data, and assessed for bias. The protocol was prospectively registered on PROSPERO (CRD: 42021224895) and reported in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. RESULTS A total of 530 citations were reviewed. Twenty-five studies, totaling 1016 patients met the inclusion criteria, including two low-quality clinical trials and 23 retrospective case series. Heterogeneity of study design and outcomes prevented meta-analysis. The overall incidence of chyle leak/fistula was 3.2%. Eighteen studies describe management of chyle leaks conservatively, 17 by surgical ligation of the thoracic duct, 5 by pleurodesis, and 6 described percutaneous lymphangiography with thoracic duct embolization or disruption. CONCLUSIONS The evidence base for optimal management of chyle leakage postesophagectomy is lacking, which may be related to its low incidence. There is a paucity of high-quality prospective studies directly comparing treatment modalities, but there is some low-certainty evidence that percutaneous approaches have reduced morbidity but lower efficacy compared with surgery. Further high-quality, prospective studies that compare interventions at different levels of severity are needed to determine the optimal approach to treatment.
Collapse
Affiliation(s)
- Robert Power
- National Oesophageal and Gastric Centre, St James's Hospital, Dublin, Ireland
| | - Philip Smyth
- National Oesophageal and Gastric Centre, St James's Hospital, Dublin, Ireland
| | - Noel E Donlon
- National Oesophageal and Gastric Centre, St James's Hospital, Dublin, Ireland
| | - Timothy Nugent
- National Oesophageal and Gastric Centre, St James's Hospital, Dublin, Ireland
| | - Claire L Donohoe
- National Oesophageal and Gastric Centre, St James's Hospital, Dublin, Ireland
| | - John V Reynolds
- National Oesophageal and Gastric Centre, St James's Hospital, Dublin, Ireland
| |
Collapse
|
12
|
Khan MS, Casson C, Bergman G, Mokdad A, Josephs S, Qureshi FG. Radiological management of traumatic lymphatic injuries in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
13
|
Rocha G, Arnet V, Soares P, Gomes AC, Costa S, Guerra P, Casanova J, Azevedo I. Chylothorax in the neonate-A stepwise approach algorithm. Pediatr Pulmonol 2021; 56:3093-3105. [PMID: 34324269 DOI: 10.1002/ppul.25601] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chylothorax in neonates results from leakage of lymph from thoracic lymphatic ducts and is mainly congenital or posttraumatic. The clinical course of the effusion is heterogeneous, and consensus on treatment, timing, and modalities of measures has not yet been established. This review aims to present, along with levels of evidence and recommendation grades, all current therapeutic possibilities for the treatment of chylothorax in neonates. METHODS An extensive search of publications between 1970 and 2020 was performed in the PubMed, Cochrane Database of Systematic Reviews, and UpToDate databases. A stepwise approach algorithm was proposed for both congenital and traumatic conditions to guide the clinician in a rational and systematic way for approaching the treatment of neonates with chylothorax. DISCUSSION AND CONCLUSION The treatment strategy for neonatal chylothorax generally involves supportive care and includes drainage and procedures to reduce chyle flow. A stepwise approach starting with the least invasive method is advocated. Progression in the invasiveness of treatment options is determined by the response to previous treatments. A practical stepwise approach algorithm is proposed for both, congenital and traumatic chylothoraces.
Collapse
Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Vanessa Arnet
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paulo Soares
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Ana Cristina Gomes
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Sandra Costa
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal
| | - Paula Guerra
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Casanova
- Department of Cardiothoracic Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Inês Azevedo
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, Universidade do Porto, Porto, Portugal.,Department of Pediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal.,EPIUnit, Public Health Institution, University of Porto, Porto, Portugal
| |
Collapse
|
14
|
Flores-Funes D, Miguel Perelló JA, Capel-Alemán A, Flores-Pastor BM. Percutaneous embolization of the thoracic duct as a therapeutic alternative to chylous fistula after thyroid surgery. ENDOCRINOL DIAB NUTR 2021; 68:211-213. [PMID: 34167701 DOI: 10.1016/j.endien.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/23/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Diego Flores-Funes
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Murcia, Spain; Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, Spain.
| | - Joana Aina Miguel Perelló
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Murcia, Spain; Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, Spain
| | - Antonio Capel-Alemán
- Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, Spain; Servicio de Radiología, Unidad de Radiología Vascular Intervencionista, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Benito Manuel Flores-Pastor
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Murcia, Spain; Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, Spain
| |
Collapse
|
15
|
Sinha S, Lee EW, Dori Y, Katsuhide M. Advances in lymphatic imaging and interventions in patients with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
16
|
Dar PMUD, Gamanagatti S, Priyadarshini P, Kumar S. Traumatic chylothorax: a dilemma to surgeons and interventionists. BMJ Case Rep 2021; 14:14/5/e238961. [PMID: 34020985 DOI: 10.1136/bcr-2020-238961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chylothorax is generally seen due to iatrogenic injury to the thoracic duct during thoracic or neck surgery. It can also be encountered secondary to chest trauma either blunt or penetrating. Percutaneous thoracic duct embolisation is an alternative to surgical treatment and is considered an effective and safe minimally invasive treatment option for chylothorax with a success rate of about 80%. We present a case of blunt trauma to the chest with chylothorax, which was successfully managed with transvenous retrograde thoracic duct embolisation.
Collapse
Affiliation(s)
- Parvez Mohi Ud Din Dar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Shivanand Gamanagatti
- Radiodiagnosis, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Pratyusha Priyadarshini
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Subodh Kumar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| |
Collapse
|
17
|
Sato Y, Tanaka Y, Imai T, Kawada H, Okumura N, Matsuhashi N, Takahashi T, Matsuo M, Yoshida K. Chylothorax after esophagectomy treated with inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization. Clin J Gastroenterol 2021; 14:969-974. [PMID: 33974188 PMCID: PMC8298363 DOI: 10.1007/s12328-021-01429-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
Chylothorax after esophagectomy is a serious complication that is associated with major morbidity due to dehydration and malnutrition. Reoperation with ligation of the thoracic duct is considered for patients with high-output chyle leaks that have failed conservative management. In this report, we present the treatment options for chylothorax after esophagectomy: inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization. A 74-year-old man with esophageal cancer had been operated with thoracoscopic esophagectomy. Six days after surgery, he presented with high-output chyle leaks. Conservative treatment did not result in a significant improvement. Inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization were performed 13 days after surgery and were technically and clinically successful. Inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization are an effective treatment option, especially for patients after esophagectomy with reconstruction performed via the posterior mediastinal route, without the potential for damage the gastric tube and omentum.
Collapse
Affiliation(s)
- Yuta Sato
- Department of Surgical Oncology, Gifu university, graduate school of Medicine, 1-1 Yanagido, Gifu city, 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Surgical Oncology, Gifu university, graduate school of Medicine, 1-1 Yanagido, Gifu city, 501-1194, Japan.
| | - Takeharu Imai
- Department of Surgical Oncology, Gifu university, graduate school of Medicine, 1-1 Yanagido, Gifu city, 501-1194, Japan
| | - Hiroshi Kawada
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Naoki Okumura
- Department of Surgical Oncology, Gifu university, graduate school of Medicine, 1-1 Yanagido, Gifu city, 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Surgical Oncology, Gifu university, graduate school of Medicine, 1-1 Yanagido, Gifu city, 501-1194, Japan
| | - Takao Takahashi
- Department of Surgical Oncology, Gifu university, graduate school of Medicine, 1-1 Yanagido, Gifu city, 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University Hospital, Gifu, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu university, graduate school of Medicine, 1-1 Yanagido, Gifu city, 501-1194, Japan
| |
Collapse
|
18
|
Froeba-Pohl A, Muehling J, Vill K, Grote V, Komm T, Seitz D, Kappler R, von Schweinitz D. Lymphatic Leakage after Surgery for Neuroblastoma: A Rare Complication? Eur J Pediatr Surg 2021; 31:140-146. [PMID: 31958864 DOI: 10.1055/s-0039-1701008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Neuroblastoma is the most common extracranial solid tumor in infancy. It is responsible for around 15% of all oncological deaths during childhood. Due to its retroperitoneal location, neuroblastoma is invasively growing directly in and around the lymphatic duct. Consecutively, lymphatic leakage (LL) after surgery for neuroblastoma is a known complication. The purpose of this study is the investigation of frequency and impact of this complication. MATERIAL AND METHODS Between February 2003 and December 2016, 204 patients with neuroblastoma received surgical treatment in our department. A retrospective analysis for macroscopical extent of resection, duration of drainage postsurgery, maximum amount of fluid drained in 24 hours, MYCN amplification status, therapeutic options for LL, follow-up status, and overall survival was performed. RESULTS A total of 40% of patients (82/204) showed LL to some extent. In patients with MYCN amplification, LL was seen significantly more often than in patients without MYCN amplification status (p = 0.019). LL was also significantly correlated with extent of surgery (p = 0.005). Follow-up status and overall survival were significantly inversely associated with LL (p = 0.004 and p = 0.0001). LL was self-limiting in all cases. There was a trend toward shorter duration of LL if either no special therapy was chosen or total parenteral nutrition (TPN) was administered (p = 0.0603). CONCLUSION We show that LL in neuroblastoma is a common complication of tumor resection and occurring more often than anticipated. Since, in our study cohort, all cases of LL were self-limiting, we question the indication for invasive therapy besides supporting measures.
Collapse
Affiliation(s)
- Alexandra Froeba-Pohl
- Department of Pediatric Surgery, Munich University Hospital Dr von Hauner Children's Hospital, Munchen, Germany
| | - Jakob Muehling
- Department of Pediatric Surgery, Munich University Hospital Dr von Hauner Children's Hospital, Munchen, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine, Munich University Hospital Dr von Hauner Children's Hospital, Munchen, Germany
| | - Veit Grote
- Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Munich University Hospital Dr von Hauner Children's Hospital, Munchen, Germany
| | - Tim Komm
- Department of Pediatric Surgery, Munich University Hospital Dr von Hauner Children's Hospital, Munchen, Germany
| | - Dorothee Seitz
- Department of Pediatrics, HELIOS Dr Horst Schmidt Hospitals, Wiesbaden, Hessen, Germany
| | - Roland Kappler
- Department of Pediatric Surgery, Munich University Hospital Dr von Hauner Children's Hospital, Munchen, Germany
| | - Dietrich von Schweinitz
- Department of Pediatric Surgery, Munich University Hospital Dr von Hauner Children's Hospital, Munchen, Germany
| |
Collapse
|
19
|
Jeon YJ, Cho JH, Hyun D, Shin S, Kim HK, Choi YS, Kim J, Zo JI, Shim YM. Management of chyle leakage after general thoracic surgery: Impact of thoracic duct embolization. Thorac Cancer 2021; 12:1382-1386. [PMID: 33783956 PMCID: PMC8088932 DOI: 10.1111/1759-7714.13914] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 01/30/2023] Open
Abstract
Background The aim of this study was to investigate the impact of thoracic duct embolization (TDE) on the management of postoperative chyle leakage. Methods We retrospectively reviewed the electronic medical record database of 4171 patients who underwent curative resection for lung or esophageal cancer between January 2015 and June 2017. We classified the period before the introduction of TDE as the first period and the period after the introduction of TDE as the second period. Results A total of 105 patients who developed chyle leakage after surgery were included. In the first period, 49 patients who underwent lung surgery developed chylothorax. Of those, two patients (4.1%) underwent surgical ligation of the thoracic duct (TD). Of eight patients with chyle leakage after esophagectomy, four patients (50%) underwent TD ligation. In the second period, 30 patients developed postoperative chyle leakage after pulmonary resection. Only one (3.3%) of them required surgical ligation. Of eight patients with chyle leakage after esophagectomy, only two (11.1%) patients underwent TD ligation. Five patients (16.7%) received TDE after lung surgery and five patients (27.7%) after esophageal surgery. Also, in the second period, the hospital stay of patients who underwent lung cancer surgery was shorter than the first period (12.6 ± 4.6 days vs. 16.3 ± 9.7 days; p = 0.026). Conclusions TDE is an effective method for the management of chyle leakage and might help to avoid invasive surgery.
Collapse
Affiliation(s)
- Yeong Jeong Jeon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
20
|
Yokokawa H, Katsube T, Miyazawa M, Nishiguchi R, Asaka S, Yamaguchi K, Murayama M, Kuhara K, Usui T, Yokomizo H, Yoshimatsu K, Shimakawa T, Shiozawa S. First successful case of percutaneous transabdominal thoracic duct embolization (PTTDE) for chylous ascites resulting from laparoscopic gastric cancer surgery. Int Cancer Conf J 2021; 10:149-153. [PMID: 33782644 PMCID: PMC7947137 DOI: 10.1007/s13691-021-00468-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/06/2021] [Indexed: 01/21/2023] Open
Abstract
A 61-year-old woman underwent laparoscopy-assisted distal gastrectomy (LADG) with extragastric lymph node dissection (D2). Two months later, she was readmitted to hospital to be treated for chylous ascites. Oral intake was discontinued and total parenteral nutrition started, but increasing body weight and decreasing serum albumin concentration was not controllable. Percutaneous transabdominal thoracic duct embolization (PTTDE) was performed on the 8th day after the readmission. Five days after PTTDE, oral intake was resumed. Seventeen days after PTTDE, the patient was discharged without recurrence of ascites. She has remained asymptomatic. We describe here the first patient with chylous ascites two months after LADG with D2 dissection for early gastric cancer who was successfully treated by PTTDE.
Collapse
Affiliation(s)
- Hideyuki Yokokawa
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
- Department of Surgery, Saitama-ken Saiseikai Kurihashi Hospital, 714-6 Koemon, Kuki, Saitama 349-1105 Japan
| | - Takao Katsube
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| | - Miki Miyazawa
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| | - Ryohei Nishiguchi
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| | - Shinichi Asaka
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| | - Kentaro Yamaguchi
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| | - Minoru Murayama
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| | - Kotaro Kuhara
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| | - Takebumi Usui
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| | - Hajime Yokomizo
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| | - Kazuhiko Yoshimatsu
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
- Department of Surgery, Saitama-ken Saiseikai Kurihashi Hospital, 714-6 Koemon, Kuki, Saitama 349-1105 Japan
| | - Takeshi Shimakawa
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| | - Shunichi Shiozawa
- Department of Surgery, Tokyo Women’s Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo, 116-8567 Japan
| |
Collapse
|
21
|
Chen C, Wang Z, Hao J, Hao X, Zhou J, Chen N, Liu L, Pu Q. Chylothorax after Lung Cancer Surgery: A Key Factor Influencing Prognosis and Quality of Life. Ann Thorac Cardiovasc Surg 2020; 26:303-310. [PMID: 32611931 PMCID: PMC7801173 DOI: 10.5761/atcs.ra.20-00039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Chylothorax is caused by the accumulation of chylous fluid in the pleural cavity due to the injury of the thoracic duct or its tributaries. Chylothorax following lung cancer surgery, especially pulmonary resection and mediastinal lymph node dissection, is a raw potential postoperative complication as previously reported. Chylothorax might lead to a high mortality rate if not addressed in a timely fashion. This article reviews the anatomy of the thoracic duct, risk factors of postoperative chylothorax, diagnoses and management with chylothorax, and intraoperative prevention of chylothorax. With the development of researches on postoperative chylothorax, more effective treatment and prevention measures need to be proposed to better solve this clinical problem.
Collapse
Affiliation(s)
- Cong Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jianqi Hao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiaohu Hao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| |
Collapse
|
22
|
Hur J, Hur S, Shin JH, Kwon SH, Hyun D, Yoon J. Reversed Approach through Lymphocele/Lymphatic Fluid Collection for Glue Embolization of Injured Lymphatic Vessels. J Vasc Interv Radiol 2020; 32:299-304. [PMID: 33257108 DOI: 10.1016/j.jvir.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022] Open
Abstract
A total of 9 glue embolization procedures of injured lymphatic vessels with a reversed approach from the lymphocele/lymphatic fluid collection in 8 patients were retrospectively reviewed. The approach routes were via the indwelling chest tube for pleural effusion (n = 2), the drainage catheter tract for abdominopelvic lymphocele/lymphatic fluid collection/thigh lymphocele (n = 4), and the direct puncture of the lymphatic fluid collection at the operation bed (n = 2). All the procedures were technically successful without complications. The mean daily leakage rate decreased from 465 mL/d before the procedure to 42 mL/d after the procedure, and the drainage catheters could be removed after 8 procedures, achieving a clinical success rate of 88.9% (8 of 9 procedures).
Collapse
Affiliation(s)
- Joonho Hur
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Saebeom Hur
- Department of Radiology Seoul National University Hospital, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea.
| | - Se Hwan Kwon
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Korea
| | - Dongho Hyun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul, Korea
| | - Jehong Yoon
- Department of Radiology, Sahmyook Medical Center, Seoul, Korea
| |
Collapse
|
23
|
Donlon NE, Nugent TS, Power R, Butt W, Kamaludin A, Dolan S, Guiney M, Mc Eniff N, Ravi N, Reynolds JV. Embolization or disruption of thoracic duct and cisterna chyli leaks post oesophageal cancer surgery should be first line management for ECCG-defined type III chyle fistulae. Ir J Med Sci 2020; 190:1111-1116. [PMID: 33040261 DOI: 10.1007/s11845-020-02396-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/07/2020] [Indexed: 11/27/2022]
Abstract
Chyle leakage from the thoracic duct or cisterna chyli is a relatively rare complication of oesophageal cancer surgery. The majority of cases settle with conservative measures, but high volume leaks may be refractory and result in significant morbidity and require intervention with reoperation or embolization. In the experience of this high-volume centre over the last decade, 3 (0.5%) patients required reoperation and ligation of the thoracic duct; for the so-called type III leaks, interventional radiological approaches were not considered. This article is built around two recent cases, where interventional radiology to embolize and disrupt complex fistulae was successfully performed. The lessons from this experience will change practice at this centre to initial lymphangiography with a view to embolization or disruption of thoracic duct and cisterna chyli leaks as first line therapy for type III chyle leaks, with surgery reserved for where this fails.
Collapse
Affiliation(s)
- Noel E Donlon
- Department of Surgery, National Oesophageal and Gastric Cancer Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland.
| | - Tim S Nugent
- Department of Surgery, National Oesophageal and Gastric Cancer Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Robert Power
- Department of Surgery, National Oesophageal and Gastric Cancer Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Waqas Butt
- Department of Surgery, National Oesophageal and Gastric Cancer Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Ahmad Kamaludin
- Department of Surgery, National Oesophageal and Gastric Cancer Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Steven Dolan
- Department of Interventional Radiology, St. James's Hospital and Beacon Hospital, Dublin, Ireland
| | - Michael Guiney
- Department of Interventional Radiology, St. James's Hospital and Beacon Hospital, Dublin, Ireland
| | - Niall Mc Eniff
- Department of Interventional Radiology, St. James's Hospital and Beacon Hospital, Dublin, Ireland
| | - Narayanasamy Ravi
- Department of Surgery, National Oesophageal and Gastric Cancer Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - John V Reynolds
- Department of Surgery, National Oesophageal and Gastric Cancer Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
24
|
Majdalany BS. Lymphatics, Long a Mystery-Primed to Make History. Semin Intervent Radiol 2020; 37:225-226. [PMID: 32773947 DOI: 10.1055/s-0040-1713439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Bill S Majdalany
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| |
Collapse
|
25
|
Majdalany BS, Sanogo ML, Pabon-Ramos WM, Wilson KA, Goswami AK, Kokabi N, Khaja MS. Complications during Lymphangiography and Lymphatic Interventions. Semin Intervent Radiol 2020; 37:309-317. [PMID: 32773956 DOI: 10.1055/s-0040-1713448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Lymphangiography as a diagnostic procedure dates back to the 1950s and was widely performed for several decades until being supplanted by other advanced imaging techniques. With the advent of thoracic duct embolization to treat chylothorax, Constantin Cope ushered in a transition from lymphangiography as a diagnostic procedure to a precursor for lymphatic intervention. Subsequently, technical modifications and applications of lymphatic embolization to other medical conditions have greatly expanded the scope and application of lymphangiography and lymphatic intervention. Although there is increasing familiarity with lymphatic interventions, few interventionalists have performed a high enough volume to be aware of potential complications and their management. Potential complications of lymphangiography and those encountered while performing lymphatic interventions are discussed along with approaches to minimize their risk and management strategies should they occur.
Collapse
Affiliation(s)
- Bill S Majdalany
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Mamadou L Sanogo
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Waleska M Pabon-Ramos
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Kyle A Wilson
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Abhishek K Goswami
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Nima Kokabi
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Minhaj S Khaja
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
26
|
Schwartz FR, James O, Kuo PH, Witte MH, Koweek LM, Pabon-Ramos WM. Lymphatic Imaging: Current Noninvasive and Invasive Techniques. Semin Intervent Radiol 2020; 37:237-249. [PMID: 32773949 DOI: 10.1055/s-0040-1713441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
After nearly disappearing, invasive lymphangiography not only has resurged, but new approaches have been developed to guide lymphatic interventions. At the same time, noninvasive lymphatic imaging is playing a larger role in the evaluation of lymphatic pathologies. Lymphangioscintigraphy, computed tomography lymphangiography, and magnetic resonance lymphangiography are increasingly being used as alternatives to invasive diagnostic lymphangiography. The purpose of this article is to review current invasive and noninvasive lymphatic imaging techniques.
Collapse
Affiliation(s)
- Fides R Schwartz
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Olga James
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Phillip H Kuo
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona
| | - Marlys H Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Lynne M Koweek
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | | |
Collapse
|
27
|
Moussa AM, Maybody M, Gonzalez-Aguirre AJ, Buicko JL, Shaha AR, Santos E. Thoracic Duct Embolization in Post-neck Dissection Chylous Leakage: A Case Series of Six Patients and Review of the Literature. Cardiovasc Intervent Radiol 2020; 43:931-937. [PMID: 32342160 DOI: 10.1007/s00270-020-02475-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/30/2020] [Indexed: 02/01/2023]
Abstract
Chylous leak is a serious complication of neck dissection. Patients are often managed conservatively, and failure of conservative management necessitates surgical management, which adds to their morbidity. We present a case series demonstrating the value of thoracic duct embolization (TDE) in management of patients with chylous leaks following neck dissection who have failed conservative management and to review the literature on this specific application of TDE. Between 2011 and 2019, six patients underwent a total of seven TDE procedures. Lymphatic leak was identified, and clinical success was achieved in all patients, with one patient requiring repeat TDE. No minor or major complications were reported. In conclusion, TDE is a safe and effective tool in management of chylous leaks following neck dissection.
Collapse
Affiliation(s)
- Amgad M Moussa
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Suite H-188, New York, NY, 10065, USA.
| | - Majid Maybody
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Suite H-188, New York, NY, 10065, USA
| | - Adrian J Gonzalez-Aguirre
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Suite H-188, New York, NY, 10065, USA
| | - Jessica L Buicko
- Department of Endocrine and General Surgery, Baptist-Bethesda Hospital, Florida Atlantic University, Boca Raton, USA
| | - Ashok R Shaha
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Ernesto Santos
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Suite H-188, New York, NY, 10065, USA
| |
Collapse
|
28
|
Utility of planning MRI in percutaneous thoracic duct embolization for chylothorax. Clin Imaging 2020; 64:43-49. [PMID: 32311633 DOI: 10.1016/j.clinimag.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/20/2020] [Accepted: 03/27/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Percutaneous thoracic duct embolization (TDE) is an accepted treatment for leaks of the central lymphatic ducts. In this study, we correlate the imaging findings on pre-procedural MRI lymphangiography with findings on conventional lymphangiography, and with operator ability to perform a technically successful TDE. The aim was to examine whether MRI is a good screening mechanism to support an invasive procedure in strong candidates, and avert one in poor candidates. MATERIALS AND METHODS MRI and conventional lymphangiograms of 96 patients (62 male and 34 female; mean age 63 ± 11 years, range 29-92 years) were retrospectively reviewed. The diameter and level of the best target for access were assessed for each study. Technical success rates were evaluated with respect to presence of a cisterna chyli, target duct size, and target level concordance. RESULTS Presence of a cisterna chyli on MRI significantly increased the likelihood of a successful TDE (68% vs. 42%, p = 0.03). Presence of a duct 4 mm or larger, by either modality, significantly improved the chance of successful TDE (for MRI, 65% vs. 41%, p = 0.04; for lymphangiography, 70% vs. 44%, p = 0.03). MRI was not helpful for localizing a lymphatic target, as less than half were seen within one and one-half vertebrae of the predicted level. There was a weak correlation (Pearson coefficient = +0.30) between duct size as measured on the two modalities. 95% of those without an identifiable target on MRI had a viable target on lymphangiography, and successful TDE was performed in 47% of those patients. CONCLUSIONS Identification of a cisterna chyli and/or 4 mm or greater target on pre-procedural MRI indicated higher likelihood of technically successful TDE. MRI did not help predict unsuccessful TDE procedures. Better target level concordance was not associated with improved technical outcomes.
Collapse
|
29
|
Lu X, Wang M, Han L, Krieger J, Noblet J, Chambers S, Itkin M, Kassab GS. Morphometry and Lymph Dynamics of Swine Thoracic Duct. Lymphat Res Biol 2020; 18:406-415. [PMID: 32202948 DOI: 10.1089/lrb.2019.0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: The goal of this study was to characterize the thoracic duct (TD) both morphologically and hemodynamically. Methods and Results: The lymphatic flow and pressure gradient from the cisterna chyli (CC) to the lymphovenous junction were measured in anesthetized swine (n = 9). After the animals were euthanized, the TD were harvested for histomorphometric analyses in which three samples were perfused with 9% gelatin to obtain the morphometry of the TD valve in both the open and closed configuration. Spectral analyses were performed. An afferent lymphatic vessel of the CC was accessed and cannulated after the animal was euthanized for casting (n = 3) to obtain morphometric data. The in vivo flow rate was 0.7 ± 0.49 mL/minute. Spectral analysis (Fast Fourier Transformation) showed correlation coefficients of 0.858 ± 0.063 and 0.586 ± 0.112 (p < 0.05) for the TD and JVPs, respectively. The average pressure gradient was 8.1 mmHg along the TD. The length of the TD was 35.6 ± 2.2 cm. The maximal width of the CC ranged from 11.4 to 15 mm. The diameter of the TD varied irregularly from 2 to 4.3 mm. The geometry of the TD leaflets was determined to have an area of 1.99 ± 0.53 mm2, a leaflet length of 3.26 ± 0.86 mm, a packet depth of 0.66 ± 0.19 mm, and a wall length of 5.46 ± 2.16 mm. The TD media thickness was ∼7 ± 3 μm. The number of valves ranged from 9 to 13 in the full length of the TD. Conclusions: A relatively constant pressure gradient in the swine TD drives lymph flow from the CC to the jugular vein. The TD is a thin-walled vessel with valves that prevent reflux of lymph flow. This study of morphometric and lymphatic dynamics is important for interventionalists to understand the anatomy and physiology of the TD to design new diagnostic, interventional procedures, and devices.
Collapse
Affiliation(s)
- Xiao Lu
- Division of Biomechanics and Mechanobiology, California Medical Innovations Institute, San Diego, California
| | | | - Ling Han
- Division of Biomechanics and Mechanobiology, California Medical Innovations Institute, San Diego, California
| | | | | | | | - Maxim Itkin
- Center for Lymphatic Imaging and Interventions, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ghassan S Kassab
- Division of Biomechanics and Mechanobiology, California Medical Innovations Institute, San Diego, California
| |
Collapse
|
30
|
Abstract
Lipiodol is an iodinated poppy seed oil first synthesized in 1901. Originally developed for therapeutic purposes, it has mainly become a diagnostic contrast medium since the 1920s. At the end of the 20th century, Lipiodol underwent a transition back to a therapeutic agent, as exemplified by its increasing use in lymphangiography and lymphatic interventions. Nowadays, indications for lymphangiography include chylothorax, chylous ascites, chyluria, and peripheral lymphatic fistula or lymphoceles. In these indications, Lipiodol alone has a therapeutic effect with clinical success in 51% to 100% of cases. The 2 main access sites to the lymphatic system for lymphangiography are cannulation of lymphatic vessels in the foot (transpedal) and direct puncture of (mainly inguinal) lymph nodes (transnodal). In case of failure of lymphangiography alone to occlude the leaking lymphatic vessel as well as in indications such as protein-losing enteropathy, postoperative hepatic lymphorrhea, or plastic bronchitis, lymphatic vessels can also be embolized directly by injecting a mixture of Lipiodol and surgical glues (most commonly in thoracic duct embolization). The aim of this article is to review the historical role of Lipiodol and the evolution of its clinical application in lymphangiography over time until the current state-of-the-art lymphatic imaging techniques and interventions.
Collapse
|
31
|
Carvajal JL, Case JB, Vilaplana Grosso F, Huynh E, Verpaalen V, Fox-Alvarez A, Regier PJ. Anatomic and volumetric characterization of the cisterna chyli using CT lymphangiography and computer-assisted design software in dogs with idiopathic chylothorax. Vet Radiol Ultrasound 2020; 61:312-321. [PMID: 32125022 DOI: 10.1111/vru.12851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/29/2019] [Accepted: 01/06/2020] [Indexed: 01/23/2023] Open
Abstract
The objectives of this retrospective, observational study were to characterize the anatomical features of the cisterna chyli (CC) in a cohort of dogs diagnosed with idiopathic chylothorax that underwent CT lymphangiography (CTLa), and to evaluate the feasibility of computer-assisted design (CAD) software to quantify volumetric measurements of the CC. Twenty-three client-owned dogs with idiopathic chylothorax were included. Additionally, CTLa was performed in three canine cadavers to assess the ability of CAD software to accurately acquire volumetric measurements. Injection sites, attenuation values, anatomic location, dimensions, and aortic diameter to CC ratio (Ao:CC) were recorded. Video records of video-assisted thoracic surgery (VATS) thoracic duct ligation (TDL) were reviewed in eight out of 23 dogs to compare operative and CTLa findings. The CC was dorsal and right-sided in 18 out of 23 dogs, located between L1 and L4 in 21 dogs, and extended as far cranially as T11 in two dogs. The median measurements for length, height, and width were 150.0, 5.5, and 13.3 mm, respectively. Median total volume was 1.82 mL. Median volumes to the right and left of the aorta were 1.46 and 0.49 mL, respectively (P = .014). Median total CC volume to body weight ratio (CC:bw) was 0.07 mL/kg. The presence of an intrathoracic CC was observed intraoperatively in six out of eight cases that underwent VATS TDL. Findings supported the use of CTLa and CAD as feasible methods for characterizing the CC in dogs diagnosed with chylothorax. These methods may facilitate interventional planning involving the CC such as embolization.
Collapse
Affiliation(s)
- Jose L Carvajal
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Federico Vilaplana Grosso
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Elizabeth Huynh
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Valentine Verpaalen
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Alexander Fox-Alvarez
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| |
Collapse
|
32
|
Majdalany BS, El-Haddad G. Contemporary lymphatic interventions for post-operative lymphatic leaks. Transl Androl Urol 2020; 9:S104-S113. [PMID: 32055491 DOI: 10.21037/tau.2019.08.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Post-operative lymphatic injuries are uncommon but increase morbidity and mortality in vulnerable patient populations. Post-surgical lymphatic leaks are most commonly a consequence of radical neck dissection, esophagectomy, and lung cancer resections or retroperitoneal surgeries such as radical nephrectomy and lymphadenectomy. Injury may occur anywhere along the lymphatic chains with most serious leaks occurring along the axial skeleton between the inguinal region and the left venous angle. The resultant clinical manifestations of a lymphatic leak are dependent on the location and severity of the lymphatic injury as well as patient factors. Treatment strategies are tailored toward the causative etiology, symptom severity, and daily leak volume with higher volume leaks warranting a more aggressive approach. Lymphangiography and lymphatic interventions, such as embolization, are increasingly applied for both the diagnosis and as a minimally invasive therapy for lymphatic injuries. Herein, a review of lymphatic anatomy, lymphangiography, and lymphatic interventions for the treatment of post-operative chylothorax, chylous ascites, and lymphocele is presented.
Collapse
Affiliation(s)
- Bill S Majdalany
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology, Emory University Hospital, NE Atlanta, GA, USA
| | - Ghassan El-Haddad
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| |
Collapse
|
33
|
Flores-Funes D, Miguel Perelló JA, Capel-Alemán A, Flores-Pastor BM. Percutaneous embolization of the thoracic duct as a therapeutic alternative to chylous fistula after thyroid surgery. ACTA ACUST UNITED AC 2019; 68:211-213. [PMID: 31883790 DOI: 10.1016/j.endinu.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Diego Flores-Funes
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Murcia, España; Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, España.
| | - Joana Aina Miguel Perelló
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Murcia, España; Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, España
| | - Antonio Capel-Alemán
- Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, España; Servicio de Radiología, Unidad de Radiología Vascular Intervencionista, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Benito Manuel Flores-Pastor
- Servicio de Cirugía General, Hospital General Universitario J.M. Morales Meseguer, Murcia, España; Universidad de Murcia, Facultad de Medicina, IMIB-Arrixaca, Campus de Excelencia Internacional Mare Nostrum, Murcia, España
| |
Collapse
|
34
|
Schild HH, Pieper CC. Where Have All the Punctures Gone? An Analysis of Thoracic Duct Embolizations. J Vasc Interv Radiol 2019; 31:74-79. [PMID: 31771898 DOI: 10.1016/j.jvir.2019.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/07/2019] [Accepted: 09/17/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To determine how frequently and how severely intra-abdominal structures are affected by transabdominal thoracic duct embolization (TDE). MATERIALS AND METHODS Thirty-five TDE procedures in 35 patients (22 male; mean age, 57 y; age range, 10-79 y) with therapy-refractory chylous effusions were evaluated in which radiopaque embolization material outlined the access route on postinterventional CT. CT data were analyzed by 2 TDE-experienced radiologists. Abdominal structures and organs transgressed by the access route were recorded, and findings were correlated with clinical postinterventional course with follow-up of at least 44 days. RESULTS Intra-abdominal structures/organs transgressed most often by the access route were the liver (n = 28), crus of the diaphragm (n = 25), pancreas (n = 14), portal vein (n = 10), duodenum (n = 7), inferior vena cava (n = 5), colon (n = 3), left renal vein (n = 2), pleura (n = 2), pericardium (n = 2), and gastric sleeve (n = 2). Pancreatitis was observed in 1 of 14 patients after pancreatic transgression. One case of clinically occult pulmonary glue migration occurred on catheter pullback through the left renal vein. Biliary peritonitis was observed after gallbladder puncture, necessitating cholecystectomy in 1 of 2 transbiliary punctures. No other relevant procedure-related complications such as hemorrhages or infectious complications were observed. CONCLUSIONS Despite transgression of intra-abdominal structures, puncture- and access-related complications of TDE are rare. Transpancreatic manipulations are reasonably well tolerated.
Collapse
Affiliation(s)
- Hans Heinz Schild
- Department of Radiology, University of Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | | |
Collapse
|
35
|
Jindal R, Singh J, Garg L, Gupta M. Diagnosis and management of traumatic bilateral chylothorax: a clinical conundrum. BMJ Case Rep 2019; 12:12/7/e229400. [PMID: 31326914 DOI: 10.1136/bcr-2019-229400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 35-year-old man was admitted in the emergency department with a complaint of progressive dyspnoea and 4-day prior history of a road traffic accident. An initial evaluation was inconspicuous and he was discharged. Clinical examination and radiological imaging suggested bilateral pleural effusion for which bilateral intercostal drains were inserted. Further pleural fluid analysis aided the diagnosis of bilateral chylothorax. A conservative approach consisting of a fat-free diet, total parenteral nutrition and octreotide therapy was started. Upon failure of conservative management, thoracic duct ligation by thoracotomy was done. Chylous output decreased dramatically and subsequently, and the patient was discharged in a healthy condition. This case illustrates intricacies involved in the diagnosis and management of traumatic chylothorax. Also, conservative treatment forms the first line of management, but if ineffective, then early surgical intervention should be considered. Early diagnosis and timely intervention are keystone factors for a better outcome.
Collapse
Affiliation(s)
- Rohit Jindal
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Jaspal Singh
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Loveleen Garg
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Mayank Gupta
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
36
|
Fujita T, Sato T, Sato K, Hirano Y, Fujiwara H, Daiko H. Clinical manifestation, risk factors and managements for postoperative chylothorax after thoracic esophagectomy. J Thorac Dis 2019; 11:S198-S201. [PMID: 30997175 DOI: 10.21037/jtd.2019.02.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Takeo Fujita
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuji Sato
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuma Sato
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuki Hirano
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hisashi Fujiwara
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroyuki Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
37
|
Kuetting D, Schild HH, Pieper CC. In Vitro Evaluation of the Polymerization Properties of N-Butyl Cyanoacrylate/Iodized Oil Mixtures for Lymphatic Interventions. J Vasc Interv Radiol 2018; 30:110-117. [PMID: 30527658 DOI: 10.1016/j.jvir.2018.07.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/26/2018] [Accepted: 07/28/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate polymerization of N-butyl cyanoacrylate (NBCA)/iodized oil mixtures for lymphatic interventions in vitro. MATERIALS AND METHODS Polymerization times of different NBCA/iodized oil mixtures (ratios of 1:0-1:7) were investigated in a static and dynamic experimental setup (performed in a lymph flow model in a silicone tube). Eight lymphatic samples with different triglyceride (TG) concentrations (low TGs, < 50 mg/dL; medium TGs, approximately 100-400 mg/dL; high TGs, > 700 mg/dL) were investigated. Morphologic changes during NBCA polymerization were monitored and recorded by video. Statistical analysis was performed with intergroup comparisons (Kruskal-Wallis test) and multiple regression analysis. RESULTS Static experiments showed increasing polymerization times with increasing concentrations of iodized oil as well as increasing concentrations of TGs. In the low-TG group, polymerization time increased from 14 s at a 1:1 ratio of NBCA to iodized oil to 1,336 s at a 1:7 ratio; times in the medium-TG group increased from 21 s (1:1) to 2,546 s (1:7), and those in the high TG group increased from 168 s (1:1) to 16,530 s (1:7). In dynamic experiments, prolongation of polymerization time was less pronounced. For low- and medium-TG groups, total occlusion of the silicon tube was observed in all cases during the embolization procedure at between 26 seconds (1:1 ratio) and 52 seconds (1:7). In the high-TG group, polymerization took considerably longer (between 43 s [1:1] and 467 s [1:7]) or failed completely. CONCLUSIONS Polymerization time of NBCA/iodized oil in lymph seems to be prolonged by increasing iodized oil and TG concentrations.
Collapse
Affiliation(s)
- Daniel Kuetting
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Claus C Pieper
- Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
| |
Collapse
|
38
|
Lymphatic interventions for isolated, iatrogenic chylous ascites: A multi-institution experience. Eur J Radiol 2018; 109:41-47. [DOI: 10.1016/j.ejrad.2018.10.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/15/2018] [Accepted: 10/19/2018] [Indexed: 11/21/2022]
|
39
|
Freeman BM, Powell BC, Devane AM, Hale AL, Gandhi SS. Traumatic Aorto-Cisterna Chlyi Fistula with Treatment of Aortic Pseudoaneurysm with CT-Guided Thrombin Injection. Ann Vasc Surg 2018; 54:145.e11-145.e14. [PMID: 29778611 DOI: 10.1016/j.avsg.2018.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Only 3 cases of aorto-cisterna chyli fistula have been described in the literature but none with a resulting pseudoaneurysm (PSA). METHODS A 68-year-old man presented following a motor vehicle collision. Imaging revealed a retroperitoneal hematoma with enhancement of the cisterna chyli, representing an aortic to cisterna chyli fistula. Three days later, computed tomography angiography showed resolution of the fistula, but revealed a PSA. The patient underwent arteriography that confirmed the PSA, and then a computed tomography-guided thrombin injection was performed. Follow-up imaging showed resolution of the PSA. RESULTS Only 3 cases of aorto-cisterna chyli fistula have been described. We hypothesize that this fistula was caused from his L2 vertebral body fracture, which avulsed the lumbar artery and injured the cisterna chyli. The cisterna chyli provided an outflow tract for the aortic injury. We believe this type of fistula follows a benign clinical course. Aorto-cisterna chyli fistula is rare, and reports point to spontaneous resolution. Our case is unique in that the patient progressed from a fistula to a PSA. Options for treatment of this PSA include covered stent graft, open repair, coil embolization, or thrombin injection. CONCLUSIONS This case report describes an extremely rare diagnosis and the natural history of this aorto-cisterna chyli fistula. Furthermore, the resulting aortic PSA was successfully treated with computed tomography-guided thrombin injection, which in the appropriate setting, should be considered an acceptable option.
Collapse
Affiliation(s)
- Brian M Freeman
- Department of Surgery, Greenville Health System, Greenville, SC
| | | | | | - Allyson L Hale
- Department of Surgery, Greenville Health System, Greenville, SC
| | - Sagar S Gandhi
- Department of Surgery, Greenville Health System, Greenville, SC
| |
Collapse
|
40
|
Affiliation(s)
- Walker M Blanding
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC
| | - Chadrick E Denlinger
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.
| |
Collapse
|
41
|
Srinivasa RN, Gemmete JJ, Osher ML, Hage AN, Chick JFB. Endolymphatic Balloon-Occluded Retrograde Abdominal Lymphangiography (BORAL) and Embolization (BORALE) for the Diagnosis and Treatment of Chylous Ascites: Approach, Technical Success, and Clinical Outcomes. Ann Vasc Surg 2018; 49:49-56. [DOI: 10.1016/j.avsg.2017.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/13/2017] [Accepted: 10/14/2017] [Indexed: 01/30/2023]
|
42
|
Nadolski GJ, Itkin M. Lymphangiography and thoracic duct embolization following unsuccessful thoracic duct ligation: Imaging findings and outcomes. J Thorac Cardiovasc Surg 2018; 156:838-843. [PMID: 29759734 DOI: 10.1016/j.jtcvs.2018.02.109] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 02/19/2018] [Accepted: 02/28/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To summarize the imaging findings and outcomes of thoracic duct (TD) embolization (TDE) performed in patients with chylous leaks persisting after TD ligation (TDL). MATERIALS AND METHODS In this review of 50 patients (30 males and 20 females; median age, 54 years) referred for TDE following unsuccessful surgical TDL, records were reviewed for lymphangiographic findings, technical success of TDE, and outcome of TDE. Comparisons between groups were performed using the Fisher exact test. RESULTS The causes of chylothorax were traumatic in 39 patients (78%) and nontraumatic in 11 (22%). Lymphangiography identified missed TDL in 30 patients (60%) and complete TDL in 15 patients (30%); however, in 12 of these 15 patients, collaterals around the ligation site supplying the leak could be identified. Incomplete ligation was observed in 4 patients (8%). In 1 patient (2%), a second TD was identified circumventing a complete ligation of the main TD. TDE was performed in 49 patients, and TD disruption was performed in 1 patient. Resolution of the chylous leak occurred in 45 patients (90%). There were 3 minor complications that resulted in no clinical sequela. CONCLUSIONS TDE produced cessation of chylous leak in the majority of the patients with persistent chylothorax after surgical TDL. Missed ligation is the most common finding on lymphangiography in patients with failed TDL. These findings support the use of image-guided closure of TD leaks.
Collapse
Affiliation(s)
- Gregory J Nadolski
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pa.
| | - Maxim Itkin
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pa
| |
Collapse
|
43
|
Arslan B, Masrani A, Tasse JC, Stenson K, Turba ÜC. Superselective retrograde lymphatic duct embolization for management of postoperative lymphatic leak. Diagn Interv Radiol 2018; 23:379-380. [PMID: 28724508 DOI: 10.5152/dir.2017.16514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lymphatic leak is a well-documented complication following neck dissection surgeries. When conservative methods fail to control the leak, thoracic duct embolization becomes an option. Transabdominal access is the standard for this procedure; however, it is not always feasible. We discuss a technique of selective lymphatic vessel embolization utilizing retrograde transvenous access.
Collapse
Affiliation(s)
- Bülent Arslan
- Department of Radiology, Rush University Medical Center, Chicago, Illinois, USA.
| | | | | | | | | |
Collapse
|
44
|
Nonthrombotic Pulmonary Embolism From Inorganic Particulate Matter and Foreign Bodies. Chest 2018; 153:1249-1265. [PMID: 29481783 DOI: 10.1016/j.chest.2018.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/22/2018] [Accepted: 02/14/2018] [Indexed: 11/22/2022] Open
Abstract
Nonthrombotic pulmonary embolism (NTPE) is a complete or partial occlusion of the pulmonary vasculature by various organic and inorganic materials. These materials include organic particulate matter (PM) such as adipocytes, tumor cells, bacteria, fungi, or gas and inorganic PM. Although NTPE due to organic PM has been extensively reported in the medical literature, there are no comprehensive reviews of inorganic material embolizing to the lungs. The purpose of this article is to examine the current literature describing NTPE resulting from inorganic PM and foreign bodies. Cases of NTPE are uncommon and often difficult to diagnose. The diagnosis is challenging due to its varied presentation, clinical features, and unusual radiologic features. In contrast to the "classic" pulmonary thromboembolism, the pathophysiologic effects of embolism by PM are not only mechanical but also a consequence of the nature of the offending material. NTPE caused by these substances can be relatively innocuous, life-threatening, or lead to chronic pulmonary disease, if left undetected. We hope that the heightened sense of awareness of this entity may allow earlier diagnosis and recognition of its complications.
Collapse
|
45
|
Ng ZQ, He B. A Proposed Classification System and Therapeutic Strategy for Chyle Leak After Laparoscopic Living-Donor Nephrectomy: A Single-Center Experience and Review of the Literature. EXP CLIN TRANSPLANT 2017; 16:143-149. [PMID: 29108520 DOI: 10.6002/ect.2016.0305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Chyle leak or chylous ascites remains a rare complication after laparoscopic living-donor nephrectomy. Its cause and management have not been well elucidated in the literature. Thus, the aim of this study was to review the incidence of chyle leak/chylous ascites after laparoscopic living-donor nephrectomy in our institute and in the literature to propose a classification system with its associated treatment strategy. MATERILAS AND METHODS In this retrospective review of laparoscopic living-donor nephrectomy patients from January 2005 to April 2016, we identified patients with chyle leak/chylous ascites along with the care performed. A proposed classification system based on our experience and literature is described. RESULTS Chylous leak developed in 4 donors (2.25%). Of the 4 donors, 3 were treated nonoperatively with diet modification and subcutaneous octreotide injection. One patient required surgical intervention after not responding to second-line therapy with total parenteral nutrition. CONCLUSIONS Chyle leak/chylous ascites after laparoscopic living-donor nephrectomy is rare, but a delayed diagnosis may lead to morbidity secondary to malnutrition and immunosuppression. Meticulous surgical dissection is essential to seal the lymphatic tubes during laparoscopic living-donor nephrectomy. The proposed classification system provides a practical and tailored guide to management based on the drainage volume of chyle leak and a guide to the earlier identification of refractory cases.
Collapse
Affiliation(s)
- Zi Qin Ng
- From the WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | | |
Collapse
|
46
|
Kariya S, Nakatani M, Ueno Y, Yoshida A, Ono Y, Maruyama T, Komemushi A, Tanigawa N. Transvenous Retrograde Thoracic Ductography: Initial Experience with 13 Consecutive Cases. Cardiovasc Intervent Radiol 2017; 41:406-414. [DOI: 10.1007/s00270-017-1814-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/09/2017] [Indexed: 11/30/2022]
|
47
|
Majdalany BS, Murrey DA, Kapoor BS, Cain TR, Ganguli S, Kent MS, Maldonado F, McBride JJ, Minocha J, Reis SP, Lorenz JM, Kalva SP. ACR Appropriateness Criteria ® Chylothorax Treatment Planning. J Am Coll Radiol 2017; 14:S118-S126. [DOI: 10.1016/j.jacr.2017.02.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 01/30/2023]
|
48
|
Kaiser LR. Non-surgical approach to the thoracic duct: a technique whose time has come. J Thorac Dis 2017; 9:428-429. [PMID: 28449435 DOI: 10.21037/jtd.2017.01.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Larry R Kaiser
- The Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| |
Collapse
|
49
|
Chang YC, Yen YT, Chang MC, Tseng YL. Localization of thoracic duct using heavily T2W MRI for intractable post-esophagectomy chylothorax-a case report. J Thorac Dis 2017; 9:E109-E114. [PMID: 28275492 DOI: 10.21037/jtd.2017.02.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Post-esophagectomy chylothorax is a rare yet serious complication. Herein we report the case of a patient with intractable post-esophagectomy chylothorax despite medical treatment with total parenteral nutrition and octreotide, as well as prophylactic and repeated thoracic duct mass ligation. The patient was eventually treated with localization of thoracic duct using T2-weighted magnetic resonance imaging (T2W MRI), followed by video-assisted thoracoscopic thoracic duct ligation.
Collapse
Affiliation(s)
- Yi-Chien Chang
- Division of Thoracic Surgery, Tainan Municipal Hospital, Show Chwan Health Care System, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Chung Chang
- Department of Nutrition, College of Medicine and Nursing, Hung Kuang University, Taichung, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| |
Collapse
|
50
|
Besselink MG, van Rijssen LB, Bassi C, Dervenis C, Montorsi M, Adham M, Asbun HJ, Bockhorn M, Strobel O, Büchler MW, Busch OR, Charnley RM, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Izbicki JR, Lillemoe KD, Neoptolemos JP, Sarr MG, Shrikhande SV, Sitarz R, Vollmer CM, Yeo CJ, Hartwig W, Wolfgang CL, Gouma DJ. Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery. Surgery 2017; 161:365-372. [PMID: 27692778 DOI: 10.1016/j.surg.2016.06.058] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Marc G Besselink
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - L Bengt van Rijssen
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudio Bassi
- Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy
| | | | - Marco Montorsi
- Department of Surgery, Humanitas Research Hospital and University, Milan, Italy
| | - Mustapha Adham
- Department of HPB Surgery, Hopital Edouard Herriot, HCL, UCBL1, Lyon, France
| | | | - Maximillian Bockhorn
- Department of General-, Visceral-, and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Strobel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Olivier R Busch
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard M Charnley
- Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Kevin C Conlon
- Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland
| | - Laureano Fernández-Cruz
- Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain
| | - Abe Fingerhut
- First Department of Digestive Surgery, Hippokrateon Hospital, University of Athens, Athens, Greece; Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jakob R Izbicki
- Department of General-, Visceral-, and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA
| | - John P Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Michael G Sarr
- Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN
| | | | - Robert Sitarz
- Department of Surgical Oncology, Medical University in Lublin, Poland
| | - Charles M Vollmer
- Department of Surgery, Penn Medicine, The University of Pennsylvania, Philadelphia, PA
| | - Charles J Yeo
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Werner Hartwig
- Division of Pancreatic Surgery, Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilians University, University of Munich, Germany
| | | | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|