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Qian J, Cai S, Lin P, Chi W, Chen C, Xu G, Xu C, Wu W, Zheng W, Zheng B. Preservation vs. dissection of inferior pulmonary ligament for thoracoscopic upper lobectomy: a prospective randomized controlled trial. World J Surg Oncol 2023; 21:313. [PMID: 37805593 PMCID: PMC10559397 DOI: 10.1186/s12957-023-03190-8] [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] [Received: 07/12/2023] [Accepted: 09/17/2023] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVES The proper procedure for inferior pulmonary ligament (IPL) during upper lobectomy remains a topic of debate. To address this matter, we carried out a trial comparing the clinical outcomes of IPL preservation versus IPL dissection during thoracoscopic upper lobectomy (TUL). METHODS Patients undergoing thoracoscopic left/right upper lobectomy (TLUL/TRUL) were assigned to either the dissection group (Group D) or the preservation group (Group P). Our primary objective was to quantify and compare the alterations in postoperative residual bronchial angle and lung volume changes between the two groups. Our secondary objective encompassed the assessment of various other intraoperative and postoperative outcomes. RESULTS Following adherence to the inclusion and exclusion criteria, we enrolled 100 patients (41 left and 59 right) in Group P and 108 patients (41 left and 67 right) in Group D for the study. Our findings revealed that in TLUL, Group P was able to reduce the degree of postoperative residual bronchial angle change (P < 0.05). Conversely, the situation was distinct for TRUL. We found no notable disparity between the two groups (P > 0.05) with regard to alterations in lung volume or the occurrence of postoperative complications-except for the duration of postoperative hospital stay (P < 0.05). CONCLUSIONS Our study suggests IPL preservation especially for TLUL when compared to TRUL, which have important implications for the clinical management of patients undergoing upper lobectomy.
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Affiliation(s)
- Jiekun Qian
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Shixian Cai
- Department of Thoracic Surgery, Jinjiang Hospital of Traditional Chinese Medicine, Quanzhou, China
| | - Pinghua Lin
- Department of Thoracic Surgery, Fuqing City Hospital, Fuzhou, China
| | - Wanzhong Chi
- Department of Thoracic Surgery, Sanming Second Hospital, Sanming, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Guobin Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Chi Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Weidong Wu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Wei Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
- Fujian Key Laboratory of Cardiothoracic Surgery (Fujian Medical University), Fuzhou, China.
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Gelfand G, Barber E. Recognition and Management of Acute and Late Complications of Pneumonectomy: Clinical Cases and Treatment. Thorac Surg Clin 2021; 31:293-302. [PMID: 34304837 DOI: 10.1016/j.thorsurg.2021.04.002] [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: 10/20/2022]
Abstract
Several important complications of pneumonectomy are discussed in a case-based format. Topics include chylothorax, cardiac herniation, postpneumonectomy syndrome, postpneumonectomy pulmonary edema, bronchopleural fistula, and empyema.
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Affiliation(s)
- Gary Gelfand
- Department of Surgery, Section of Thoracic Surgery, University of Calgary, Foothills Medical Centre, Room G33H, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada.
| | - Evan Barber
- Department of Surgery, Section of Thoracic Surgery, University of Calgary, Foothills Medical Centre, Room G33H, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9, Canada
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Zaalouk TM, Bitar ZI, Maadarani OS, El‐shably ALAM. White lung with milky effusion. Clin Case Rep 2020; 8:2557-2560. [PMID: 33363779 PMCID: PMC7752631 DOI: 10.1002/ccr3.3207] [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: 06/03/2020] [Revised: 06/30/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
Thoracic duct injury is a rare complication of dorsal spine operations. Ultrasound chest plays an important tool for rapid diagnosis of acute dyspnea, drainage of massive effusion, and daily follow-up. Conservative treatment of postoperative chylous with measures to decrease chylous formation can lead to a resolution of chylothorax.
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Lv H, Zhou R, Zhan X, Di D, Qian Y, Zhang X. The choice of dissection or preservation of the inferior pulmonary ligament after an upper lobectomy: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:5. [PMID: 31901232 PMCID: PMC6942349 DOI: 10.1186/s12957-019-1777-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/23/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The necessity of the inferior pulmonary ligament (IPL) dissection after an upper lobectomy remains controversial. This meta-analysis aimed to evaluate whether this accessional procedure could reduce the postoperative complications and improve outcomes. METHODS PubMed, Embase, Ovid, Cochrane Library, CBM, and CNKI databases were searched for the relevant studies which compared the dissection with preservation of IPL during the upper lobectomy. The Review Manager 5.3 software was used for this meta-analysis. RESULTS Three RCTs and five CCTs were included in this meta-analysis. These studies contained a total of 610 patients, in which 315 patients received a pulmonary ligament dissection (group D) after the upper lobectomy, while the other 295 patients preserved the pulmonary ligament (group P). No significant difference was demonstrated between the group D and group P in terms of drainage time after surgery (MD 0.14, 95%CI - 0.05 to 0.33, P = 0.15), rate of postoperative dead space (OR 1.33, 95%CI 0.72 to 2.46, P = 0.36), rate of postoperative complications (OR 1.20, 95%CI 0.66 to 2.19, P = 0.56). However, the pooled comparison revealed a greater change of the right main bronchial angle (MD 5.00, 95%CI 1.68 to 8.33, P = 0.003) in group D compared with group P, indicated that the dissection of IPL may lead to a greater distortion of bronchus. CONCLUSIONS This meta-analysis confirmed that the dissection of IPL do not effectively reduce the postoperative complications and improve the prognosis. Therefore, it is not necessary to dissect the IPL after an upper lobectomy.
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Affiliation(s)
- Hao Lv
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China
| | - Rui Zhou
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China
| | - Xianghong Zhan
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China
| | - Dongmei Di
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China
| | - Yongxian Qian
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China
| | - Xiaoying Zhang
- Department of Cardiothoracic Surgery, The third affiliated hospital of Soochow University, 185 Juqian street, Changzhou, 213000, Jiangsu Province, China.
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Ishida T, Kanamori J, Daiko H. Lymphangiography and focal pleurodesis treatment of chylothorax with an aberrant thoracic duct following oesophagectomy: a case report. Surg Case Rep 2019; 5:195. [PMID: 31828443 PMCID: PMC6906276 DOI: 10.1186/s40792-019-0709-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background Management of postoperative chylothorax usually consists of nutritional regimens, pharmacological therapies such as octreotide, and surgical therapies such as ligation of thoracic duct, but a clear consensus is yet to be reached. Further, the variation of the thoracic duct makes chylothorax difficult to treat. This report describes a rare case of chylothorax with an aberrant thoracic duct that was successfully treated using focal pleurodesis through interventional radiology (IVR). Case presentation The patient was a 52-year-old man with chylothorax after a thoracoscopic oesophagectomy for oesophageal cancer. With conventional therapy, such as thoracostomy tube, octreotide or fibrogammin, a decrease in the amount of chyle was not achieved. Therefore, we performed lymphangiography and pleurodesis through IVR. The patient appeared to have an aberrant thoracic duct, as revealed by magnetic resonance imaging (MRI); however, after focal pleurodesis, the leak of chyle was diminished, and the patient was discharged 66 days after admission. Conclusions Chylothorax remains a difficult complication. Focal pleurodesis through IVR can be one of the options to treat chylothorax.
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Affiliation(s)
- Tomoyuki Ishida
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Jun Kanamori
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Sato Y, Iyomasa S. Chylothorax after hepatectomy: a case report. J Med Case Rep 2018; 12:347. [PMID: 30474568 PMCID: PMC6260677 DOI: 10.1186/s13256-018-1882-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/15/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Chylothorax is the accumulation of chyle within the pleural space. Chylothorax can occur as a complication after multiple different types of surgery, most frequently after thoracic surgery, albeit with an incidence rate of less than 1%. Chylothorax after abdominal surgery is extremely rare, and there are only a few case reports. CASE PRESENTATION A 74-year-old Japanese woman presented with jaundice. She was diagnosed as having hilar cholangiocarcinoma and underwent right hepatectomy, caudate lobectomy, extrahepatic bile duct resection, and lymph node dissection after preoperative percutaneous transhepatic portal vein embolization. Postoperative liver function was normal. She developed chylous ascites on postoperative day 5, for which conservative treatment was initially effective. Dyspnea developed suddenly on postoperative day 42, and she had a massive right pleural effusion and a small amount of ascites. Management with pleural drainage, total parenteral nutrition, and octreotide injections decreased the chylothorax. However, the chylous effusion reaccumulated on postoperative day 57. As conservative treatments ultimately failed, lymphangiography was performed on postoperative day 62. Lymphangiography with Lipiodol (ethiodized oil) revealed extravasation into the pleural space, but the location of the leak was not identified. There was neither obstruction nor dilation of the thoracic duct. A lymphatic leak in her abdominal cavity was not demonstrated. A chest tube was placed after lymphangiography, and the chylothorax was diminished by postoperative day 71. She was discharged on postoperative day 72. Two and a half years after surgery, she is doing well with no evidence of recurrence of either chylothorax or cancer. CONCLUSIONS Chylothorax can occur after hepatectomy and pleural effusion should raise suspicion for chylothorax. Lymphangiography may be effective for both diagnosis and treatment in the case of chylothorax after hepatectomy.
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Affiliation(s)
- Ryusei Yamamoto
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan.
| | - Yasuji Mokuno
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Hideo Matsubara
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Hirokazu Kaneko
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
| | - Yozo Sato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
| | - Shinsuke Iyomasa
- Department of Surgery, Yachiyo Hospital, 2-2-7, Sumiyoshi-cho, Anjo-shi, Aichi, 446-8510, Japan
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Alamdari DH, Asadi M, Rahim AN, Maddah G, Azizi S, Shahidsales S, Mehrabibahar M. Efficacy and Safety of Pleurodesis Using Platelet-Rich Plasma and Fibrin Glue in Management of Postoperative Chylothorax After Esophagectomy. World J Surg 2017; 42:1046-1055. [DOI: 10.1007/s00268-017-4242-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Seok Y, Yi E, Cho S, Jheon S, Kim K. Perioperative outcomes of upper lobectomy according to preservation or division of the inferior pulmonary ligament. J Thorac Dis 2015; 7:2033-40. [PMID: 26716043 DOI: 10.3978/j.issn.2072-1439.2015.11.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between inferior pulmonary ligament division and postoperative complications. METHODS Medical records of 72 non-small cell lung cancer (NSCLC) patients who underwent video-assisted thoracic surgery (VATS) upper lobectomy between March 2012 and November 2013 performed by a single thoracic surgeon at our center were reviewed retrospectively. Patients were categorized into two groups: the division group, who underwent division of the inferior pulmonary ligament, and the preservation group, who did not. The division group included 43 patients (27 right, 16 left), while the preservation group included 29 (11 right, 18 left). Postoperative outcomes such as the presence of pleural effusion, chest tube duration, and changes in the angle and diameter of remnant bronchus were compared; bronchial diameter and angle were measured on three-dimensional (3D) reconstruction chest CT images. RESULTS Chest tube duration, duration of chest tube drainage >200 mL, and the presence of pleural effusion on chest X-rays taken 1 month after surgery were not significantly different between the two groups (P=0.07, 0.33, and 1.00, respectively). There were also no significant differences between groups in the presence of apical dead space or in change in bronchial angle (P=0.22 and 0.74, respectively). In 3D reconstruction images, changes in the diameter of the right middle, right lower, and left lower lobar (LLL) bronchi were similar between groups (P=0.72, 0.12 and 0.29, respectively). Change in the angle between the right bronchus intermedius (RBI) and the right middle lobar (RML) bronchus and between the RBI and the right lower lobar (RLL) bronchus were significantly different between the division and preservation groups (P=0.02 and 0.05, respectively). CONCLUSIONS Inferior pulmonary ligament division had no clear benefits. Complications related to excessive dislocation of remnant bronchi might be associated with inferior pulmonary ligament division, but further research is needed to elucidate this relationship.
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Affiliation(s)
- Yangki Seok
- 1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Medical Center, Seoul, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eunjue Yi
- 1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Medical Center, Seoul, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sukki Cho
- 1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Medical Center, Seoul, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Jheon
- 1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Medical Center, Seoul, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwhanmien Kim
- 1 Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Medical Center, Seoul, Republic of Korea ; 2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Misthos P, Kanakis MA, Lioulias AG. Chylothorax complicating thoracic surgery: conservative or early surgical management? Updates Surg 2012; 64:5-11. [DOI: 10.1007/s13304-012-0133-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 01/04/2012] [Indexed: 11/30/2022]
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Zerrweck C, Caiazzo R, Arnalsteen L, Dezfoulian G, Porte H, Pattou F. Chylothorax: Unusual Complication After Laparoscopic Gastric Banding. Obes Surg 2009; 19:667-70. [DOI: 10.1007/s11695-008-9798-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 12/17/2008] [Indexed: 11/24/2022]
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Erkrankungen von Bronchien, Lunge, Pleura. CHIRURGISCHE INTENSIVMEDIZIN 2007. [PMCID: PMC7121802 DOI: 10.1007/978-3-211-29682-0_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Abstract
Chylothorax is a rare complication of pulmonary resection. It requires prompt treatment, which is initially conservative. This treatment consists of drainage, nutritional support, and measures to diminish chyle flow. Surgical intervention is indicated when conservative management is ineffective. Delay in surgical intervention leads not only to serious metabolic, nutritional, and immunologic disturbances from the loss of chyle but also increases the risk for adhesion formation, loculation, organization, and infection of the chylothorax, making subsequent surgical attempts difficult and increasing postoperative morbidity and mortality. VATS provides a minimally invasive approach for the treatment of chylothorax complicating pulmonary resection. Clipping of the thoracic duct or chemical pleurodesis may be performed with minimal morbidity and mortality. Conservative treatment is expensive and fails in most patients who have high-output chylous fistulae. On the other hand, VATS is uniformly effective, is less expensive, and has low morbidity. Indeed, VATS is rapidly becoming the preferred approach for the management of chylothorax complicating pulmonary resection. The need to prevent the occurrence of a chylothorax by careful dissection techniques and liberal clipping of lymphatic vessels particularly in areas of high anatomic risk during the initial operation cannot be overemphasized.
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Affiliation(s)
- Ioannis E Platis
- General Surgery Program, State University of New York at Buffalo, 193 Summer Street, Buffalo, NY 14222, USA
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Abstract
Most pleural effusions are caused by hydrostatic and oncotic pressure imbalance, inflammation or infection, or abnormalities in lymphatic drainage. A select number of effusions are caused by fluid of extravascular origin. Some of these effusions result from complications of treatment, whereas others are a ramification of the underlying disease. The incidence, pathogenesis, clinical presentation, chest radiographic manifestations, pleural fluid analysis, diagnosis, and management are discussed.
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Affiliation(s)
- Steven A Sahn
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 812-CSB, PO Box 250630, Charleston, SC 29425, USA.
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Abstract
OBJECTIVES To characterize the etiology of chylothorax in patients encountered at a single tertiary referral center and to compare the findings with those from previous studies. PATIENTS AND METHODS The medical records of all patients with chylothorax seen at the Mayo Clinic in Rochester, Minn, over a 21-year period, from January 1, 1980, to December 31, 2000, were retrospectively reviewed to ascertain the underlying cause of their condition. RESULTS We identified 203 patients with chylothorax; 92 were females (male-female ratio, 1.21). The median age was 54.5 years (range, 21 weeks' gestation to 93 years). Dyspnea, the most common presenting symptom, occurred in 98 (56.6%) of 173 patients in whom initial symptoms were recorded, whereas 64 (37.0%) had no respiratory symptoms. Median duration of symptoms before diagnosis was 7.5 weeks (range, 1 day to 4.5 years). Causes of chylothorax included surgery or trauma in 101 patients (49.8%), various medical conditions in 89 (43.8%), and unknown in 13 (6.4%). Among surgical procedures, esophagectomy (29 patients) and surgery for congenital heart disease (28 patients) were the most common causes of chylothorax. Among medical conditions, lymphoma (23 patients), lymphatic disorders (19 patients), and chylous ascites (16 patients) were the most common causes. CONCLUSIONS Chylothorax has numerous causes. In contrast to previous studies, surgery or trauma was the most common cause of chylothorax at our institution, accounting for nearly 50% of cases. Lymphoma and other malignancies caused chylothorax in only 16.7% of cases. These numbers are possibly related to the high volume of cardiothoracic surgical procedures performed at our tertiary referral center.
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Affiliation(s)
- Clinton H Doerr
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Ziedalski TM, Raffin TA, Sze DY, Mitchell JD, Robbins RC, Theodore J, Faul JL. Chylothorax after heart/lung transplantation. J Heart Lung Transplant 2004; 23:627-31. [PMID: 15135382 DOI: 10.1016/s1053-2498(03)00227-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2002] [Revised: 04/20/2003] [Accepted: 05/08/2003] [Indexed: 11/25/2022] Open
Abstract
Chylothorax is a potentially serious complication of lung and heart-lung transplantation. This article describes the clinical course of chylothorax in 3 heart-lung allograft recipients. We discuss management options, including dietary modifications, octreotide infusion, thoracic duct ligation and embolization, and surgical pleurodesis. In addition, we describe the novel use of aminocaproic acid to reduce lymph flow. We propose a multidisciplinary approach for the management of chylothorax that includes both medical and surgical options.
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Affiliation(s)
- Tomasz M Ziedalski
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, California 94305, USA
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Kanzaki M, Sasano S, Murasugi M, Oyama K, Kuwata H, Onuki T. Early endoscopic treatment of chylothorax develops after surgical treatment of lung cancer patients. ACTA ACUST UNITED AC 2003; 51:506-10. [PMID: 14621011 DOI: 10.1007/s11748-003-0111-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Chylothorax which occasionally develops after surgical treatment of lung cancer is generally treated conservatively, and surgical treatment is limited to patients who do not respond well to conservative treatment. SUBJECTS AND METHODS Of the 941 lung cancer operation, 6 patients in whom Chylothorax developed after surgical treatment of lung cancer were evaluated for its characteristics and outcome. RESULTS Two patients underwent thoracoscopic treatment. The duration of drainage was shorter for the 2 patients undergoing chylothorax operation than for the 4 patients who underwent conservative treatment. The mean duration of hospitalization after surgical treatment of lung cancer was 24 days for the patients who underwent conservative treatment alone and 12.5 days for the patients who underwent chylothorax operation. CONCLUSION Patients in whom chylothorax develops after surgical treatment of lung cancer should promptly undergo operation when the volume of chylous fluid is not decreased by conservative treatment.
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Affiliation(s)
- Masato Kanzaki
- Department of Surgery I, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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Abstract
Chylothorax is an unusual complication of surgical procedures within the chest. Early recognition is important so that appropriate conservative measures can be applied. Operative intervention after a short course of supportive therapy will control most chyle fistulas. Methods of diagnosis in the postoperative setting and literature supporting various treatment options are the focus of this article.
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Affiliation(s)
- David W Johnstone
- Department of Cardiothoracic Surgery, University of Rochester School of Medicine & Dentistry, 601 Elmwood Avenue, Box Surgery, Rochester, NY 14642, USA.
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Abstract
Chronic lymphocytic leukemia (CLL) is rarely complicated by chylothorax: we present a 93-year-old woman with CLL who developed recurrent pleural effusions that were ultimately found to be chylous in nature. Despite eight repeated thoracenteses, she continued to experience re-accumulation of fluid, and therefore, video-assisted thoracotomy with mass ligation of the thoracic duct region plus pleurodesis was performed to resolve the chylothorax. Despite her age and underlying disease, she did well during follow-up. The etiology and management of chylothorax are also reviewed.
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Affiliation(s)
- Clinton H Doerr
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Abstract
Despite the increasing obesity of the American population, many chronically ill patients are malnourished. When this malnutrition is combined with the hypermetabolic response and protein catabolism of an acute event, such as an operation, nutritional support becomes an important facet for optimal critical care. This chapter reviews the basic tenants of nutritional support with special emphasis on patients with pulmonary compromise. Important aspects of caloric and protein support are discussed and enteral nutrition is emphasized because of its numerous advantages and documented improvement in outcome.
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Affiliation(s)
- Katherine Trahan
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1173, USA.
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Wurnig PN, Hollaus PH, Ohtsuka T, Flege JB, Wolf RK. Thoracoscopic direct clipping of the thoracic duct for chylopericardium and chylothorax. Ann Thorac Surg 2000; 70:1662-5. [PMID: 11093506 DOI: 10.1016/s0003-4975(00)01921-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chylothorax is a challenging clinical problem. Untreated, it carries a high mortality and morbidity. Traditional surgical management for cases refractory to conservative treatment is thoracic duct ligation through a right open thoracotomy. METHODS We describe 4 patients treated successfully by video-assisted thoracic surgery, using ports and no thoracotomy, and precise ligation and division of the thoracic duct just above the diaphragm. A pericardial window was made in the patient with chylopericardium, as in the patient with end-stage renal disease. Pleurodesis was used in the patient with esophageal carcinoma and the patient with jugular and subclavian vein thrombosis. RESULTS There were 2 women aged 18 and 42 years and 2 men, aged 61 and 65 years. No procedure-related mortality or morbidity occurred. In patients 1, 2, 3, and 4, the postoperative duration of drainage was 5, 7, 7, and 5 days, respectively (mean duration, 6 days) and the hospital stay, 5, 9, 10, and 5 days, respectively (mean stay, 7 days). There was no recurrence of chylothorax or chylopericardium during follow-up (range, 2 to 24 months; mean follow-up, 9 months). One patient died of esophageal carcinoma 4 months after operation. CONCLUSIONS Video-assisted thoracic surgery without a thoracotomy is an effective way of treating chylothorax and carries minimal morbidity.
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Affiliation(s)
- P N Wurnig
- Department of Surgery, The Christ Hospital, University of Cincinnati, Ohio, USA
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23
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Quilotórax iatrogénico: una complicación del tubo de drenaje pleural. An Pediatr (Barc) 2000. [DOI: 10.1016/s1695-4033(00)78635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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24
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Affiliation(s)
- S E Kopec
- Department of Medicine, University of Massachusetts Medical School, Worcester 01655, USA
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25
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Abstract
Four cases of postoperative chylothorax occurring at this institution over the past 5 years, as well as an extensive review of the world literature, are presented. Of the four cases, three occurred after resection of carcinoma of the lung and one after resection of recurrent chondrosarcoma of the chest wall. These patients were treated nonoperatively for varying periods of time ranging from 2 days to nearly 3 weeks. Subsequently, all patients underwent ligation of the thoracic duct. Early reoperation for ligation of the thoracic duct resulted in no morbidity or mortality. In one case of delayed thoracic duct ligation, after an attempt at ligation of minor lymphatic vessels, the single mortality occurred. In view of the experience with these patients and that reported in the literature, we propose that not only is thoracic duct ligation superior to nonoperative management, but that it should be undertaken without delay.
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Affiliation(s)
- E M Sieczka
- Department of General Surgery, Beth Israel Medical Center, New York, New York, USA
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