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Zhang X, Hu XJ, Hua KJ. Endoscopic hemithyroidectomy plus prophylactic central neck dissection via breast approach versus gasless transaxillary approach in treating low-risk papillary thyroid cancer: a retrospective series. Updates Surg 2023; 75:707-715. [PMID: 36848003 DOI: 10.1007/s13304-023-01486-8] [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: 11/28/2022] [Accepted: 02/23/2023] [Indexed: 03/01/2023]
Abstract
Hemithyroidectomy plus prophylactic central neck dissection (pCND) has been adopted as a de-escalating surgical strategy for low-risk papillary thyroid cancer (PTC). This study aimed to evaluate and compare the outcomes of these two different endoscopic approaches in the treatment of PTC with hemithyroidectomy plus pCND. This retrospective study reviewed medical records of 545 patients receiving breast approach (ETBA) (n = 263) or gasless transaxillary approach (ETGTA) (n = 282) in treating PTC. Demographics and outcomes were compared between the two groups. Preoperatively, the two groups were similar in demographics. Regarding surgical outcomes, no differences were found in terms of intraoperative bleeding, total amount of drainage, duration of drainage, postoperative pain, hospital stay, vocal cord palsy, hypoparathyroidism, hemorrhage, wound infection, chyle leakage, or subcutaneous ecchymosis. Conversely, ETBA recorded fewer skin paresthesia (1.5% vs. 5.0%, respectively) but longer operative times (138.1 ± 27.0 vs. 130.9 ± 30.8 min,) and more swallowing disturbances (3.4% vs. 0.7%) compared to ETGTA (p < 0.05). No difference in scar cosmetic results, but ETBA had lower neck assessment score than ETGTA (2.6 ± 1.2 vs. 3.2 ± 2.0, p < 0.05). For low-risk PTC, endoscopic hemithyroidectomy plus pCND using either ETBA or ETGTA is both feasible and safe. Although the two approaches are comparable in terms of most surgical and oncological outcomes, ETBA is superior to ETGTA in terms of neck cosmetic results and skin paresthesia but is associated with more swallowing disturbances and requires a longer operative time.
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Affiliation(s)
- Xing Zhang
- Department of Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University, Ningbo, 315040, Zhejiang, China.
| | - Xian-Jie Hu
- Department of Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University, Ningbo, 315040, Zhejiang, China
| | - Ke-Jun Hua
- Department of Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University, Ningbo, 315040, Zhejiang, China
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2
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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.
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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
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Baldini L, Librandi K, D’Eusebio C, Lezo A. Nutritional Management of Patients with Fontan Circulation: A Potential for Improved Outcomes from Birth to Adulthood. Nutrients 2022; 14:nu14194055. [PMID: 36235705 PMCID: PMC9572747 DOI: 10.3390/nu14194055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022] Open
Abstract
Fontan circulation (FC) is a surgically achieved palliation state offered to patients affected by a wide variety of congenital heart defects (CHDs) that are grouped under the name of univentricular heart. The procedure includes three different surgical stages. Malnutrition is a matter of concern in any phase of life for these children, often leading to longer hospital stays, higher mortality rates, and a higher risk of adverse neurodevelopmental and growth outcomes. Notwithstanding the relevance of proper nutrition for this subset of patients, specific guidelines on the matter are lacking. In this review, we aim to analyze the role of an adequate form of nutritional support in patients with FC throughout the different stages of their lives, in order to provide a practical approach to appropriate nutritional management. Firstly, the burden of faltering growth in patients with univentricular heart is analyzed, focusing on the pathogenesis of malnutrition, its detection and evaluation. Secondly, we summarize the nutritional issues of each life phase of a Fontan patient from birth to adulthood. Finally, we highlight the challenges of nutritional management in patients with failing Fontan.
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Affiliation(s)
- Letizia Baldini
- Postgraduate School of Pediatrics, University of Turin, 10126 Turin, Italy
- Pediatria Specialistica, Ospedale Infantile Regina Margherita, Piazza Polonia 94, 10126 Torino, Italy
- Correspondence:
| | - Katia Librandi
- Postgraduate School of Pediatrics, University of Turin, 10126 Turin, Italy
| | - Chiara D’Eusebio
- Dietetic and Clinical Nutrition Unit, Pediatric Hospital Regina Margherita, University of Turin, 10126 Turin, Italy
| | - Antonella Lezo
- Dietetic and Clinical Nutrition Unit, Pediatric Hospital Regina Margherita, University of Turin, 10126 Turin, Italy
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4
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Ding Z, Chen M, Pang R, Sheng R, Zhao X, Nie C. Case report: Balloon compression for cervical chyle leakage post neck dissection. Front Surg 2022; 9:1019425. [PMID: 36211290 PMCID: PMC9537764 DOI: 10.3389/fsurg.2022.1019425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 12/01/2022] Open
Abstract
Postoperative chyle leakage (CL) is a rare but severe complication after neck dissection, and most patients with this complication can be treated conservatively. However, in patients with high-flow leakage, efficient and well-tolerated conservative treatment options are still lacking, and the treatments can be complicated. In this study, we report a case with CL of 1100 ml/day after neck dissection that was successfully treated by balloon compression.
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Effect of a Polyglycolic Acid Mesh Sheet (Neoveil™) in Thyroid Cancer Surgery: A Prospective Randomized Controlled Trial. Cancers (Basel) 2022; 14:cancers14163901. [PMID: 36010894 PMCID: PMC9406169 DOI: 10.3390/cancers14163901] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Papillary thyroid cancer (PTC) is the most common type of thyroid cancer. Surgery for PTC involves resection of the thyroid gland and lymph node dissection around thyroid. Lymph node dissection is associated with an increased amount of fluid from the dissection area and chyle leakage due to thoracic duct injury. A polyglycolic acid mesh sheet (Neoveil™) has been proven to prevent postoperative fluid leakage in other surgeries. So, we aim to evaluate whether Neoveil™ can reduce postoperative drainage and chyle leakage in surgery for PTC. With the use of Neoveil™, the amount of drainage significantly decreased on the postoperative 2nd day and postoperative total drainage amount was lower. Triglyceride level was lower in the Neoveil™ group but was not statistically significant. No adverse effect from the Neoveil™ was observed during 9 months follow up. Our study suggests that Neoveil™ can be applied to reduce postoperative drainage in thyroid surgery for PTC. Abstract Papillary thyroid cancer (PTC) is the most common type of thyroid cancer. Surgery for PTC involves resection of the thyroid gland and central lymph node dissection. Central lymph node dissection is associated with an increased amount of fluid from the dissection area and chyle leakage due to thoracic duct injury. There are few studies that deal with reducing fluid drainage and preventing chyle leakage after thyroid surgery with central lymph node dissection. A polyglycolic acid mesh sheet (Neoveil™) has been demonstrated to prevent postoperative fluid leakage in other surgeries. This study aims to evaluate whether a polyglycolic acid mesh sheet can reduce postoperative drainage and chyle leakage in papillary thyroid cancer surgery, and this study was designed as a prospective, open-label, randomized controlled trial in a single university hospital. The patients were randomly assigned to having only fibrin glue used in the central node dissection area (control group) or to having a polyglycolic acid mesh sheet applied after fibrin glue (treatment group). A total of 330 patients were enrolled, of which 5 patients were excluded. A total of 161 patients were included in the treatment group, and 164 patients were included in the control group. The primary outcome was the drainage amount from the Jackson-Pratt drain, and the secondary outcome was the triglyceride level in the drained fluid on the 1st and 2nd postoperative days. The drainage amount was significantly lower in the treatment group on the 2nd postoperative day (60.9 ± 34.9 mL vs. 72.3 ± 38.0 mL, p = 0.005). The sum of drainage amount during the whole postoperative days (1st and 2nd days) was also significantly lower in the treatment group (142.7 ± 71.0 mL vs. 162.5 ± 71.5 mL, p = 0.013). The postoperative triglyceride levels were lower in the treatment group but were not statistically significant (92.1 ± 60.1 mg/dL vs. 81.3 ± 58.7 mg/dL on postoperative day 1, p = 0.104 and 67.6 ± 99.2 mg/dL vs. 53.6 ± 80.4 mg/dL on postoperative day 2, p = 0.162). No adverse effects were observed in the treatment groups during the postoperative 9-month follow-up. Our study suggests that polyglycolic acid mesh sheets can be safely applied to reduce postoperative drainage amount in thyroidectomy patients who need lymph node dissection.
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Kashoob M, Bawain S, Al Badaai Y. Bilateral Chylothorax Following Total Thyroidectomy with Neck Dissection for Papillary Thyroid Cancer: Case report. Sultan Qaboos Univ Med J 2021; 21:481-484. [PMID: 34522417 PMCID: PMC8407900 DOI: 10.18295/squmj.4.2021.018] [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] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/15/2020] [Accepted: 10/14/2020] [Indexed: 11/17/2022] Open
Abstract
Bilateral chylothorax is a rare condition that occurs after a thyroidectomy and neck dissection, which can lead to severe morbidity and, potentially, death, if not managed properly. We report a rare complication of neck surgery and subsequent bilateral pleural effusion in a 35-year-old female patient who presented at Sultan Qaboos University Hospital in 2018 with shortness of breath and respiratory distress. The bilateral pleural effusion and related symptoms occurred one week after a total thyroidectomy with central and left lateral neck dissection. The patient was managed conservatively and subsequently recovered.
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Affiliation(s)
- Musallam Kashoob
- Departments of Ear, Nose and Throat, Oman Medical Specialty Board, Muscat, Oman
| | - Saleh Bawain
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Yahya Al Badaai
- Department of Surgery, Sultan Qaboos University, Muscat, Oman
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Comparison of the transoral endoscopic thyroidectomy vestibular approach and open thyroidectomy: A propensity score-matched analysis of surgical outcomes and safety in the treatment of papillary thyroid carcinoma. Surgery 2021; 170:1680-1686. [PMID: 34284897 DOI: 10.1016/j.surg.2021.06.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/10/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The transoral endoscopic thyroidectomy vestibular approach has been demonstrated to have similar surgical outcomes as open thyroidectomy for selected papillary thyroid carcinomas. This study aimed to evaluate and compare the surgical outcomes and safety of the transoral endoscopic thyroidectomy vestibular approach with those of open thyroidectomy in the treatment of papillary thyroid carcinoma with a diameter between >1 cm and ≤3.5cm. METHODS We retrospectively reviewed all patients who had papillary thyroid carcinoma that was between >1 cm and ≤3.5 cm in diameter and who had undergone the transoral endoscopic thyroidectomy vestibular approach (n = 96) or an open thyroidectomy (n = 425) from January 2017 to June 2020. We then performed 1:1 propensity score matching, yielding 78 matched pairs. Afterward, surgical outcomes and follow-up data were compared between the 2 matched groups. RESULTS Compared with the matched open thyroidectomy group, the papillary thyroid carcinoma group had a significantly longer operative time (P < .001), more blood loss (P < .05), higher postoperative white blood cell count (P < .05), higher C-reactive protein (P < .001), more total drainage volume (P < .001), increased surgical cost (P < .05), better cosmetic satisfaction (P <.001), lower scar self-consciousness (P < .001), and better quality of life (P < .001). We observed no significant differences in the incidence of other outcomes, including the number of retrieved lymph nodes and metastatic central lymph nodes, the rate of intraoperative recurrent laryngeal nerve signal weakened and parathyroid autotransplantation, visual analog scale scores for pain, drainage duration, postoperative hospital stay, rate of complications, and oncologic completeness. We observed no conversion to open thyroidectomy and no intraoperative capsular disruption in the transoral endoscopic thyroidectomy vestibular approach group. There was 1 case of persistent nodal disease in the transoral endoscopic thyroidectomy vestibular approach group. No recurrence was observed in the 2 groups during the follow-up period. CONCLUSION The transoral endoscopic thyroidectomy vestibular approach is feasible in selected patients with papillary thyroid carcinoma, not only because it is cosmetically advantageous but also because it is surgical and oncologically safe and may be an optional surgical method for treating papillary thyroid carcinomas having a diameter between >1 cm and ≤3.5 cm.
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8
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Kim CW, Kim JS, Lee AH, Kim YS. Viscum album extract (Helixor-M) treatment for thoracic duct injury after modified radical neck dissection: a case report. Gland Surg 2021; 10:832-836. [PMID: 33708565 DOI: 10.21037/gs-20-629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chyle leakage after modified radical neck dissection is a rare condition that could be occasionally life-threatening if untreated. We report the first case of successful management of a thoracic duct injury using Viscum album extract (Helixor-M). A 54-year-old woman diagnosed with papillary thyroid cancer of the right lobe of the thyroid with metastasis to cervical lymph node levels II-VI, bilaterally, underwent total thyroidectomy and modified radical neck dissection. Three days postoperatively, the surgical team identified a thoracic duct injury due to drainage of chyle from the Jackson-Pratt drain inserted in the right side of the patient`s neck. Various medical treatments (octreotide, withdrawal of enteral feeding, and total parenteral nutrition) and surgical treatments [lymphatic ligation of cervical lymph node level IV and negative pressure wound therapy (vacuum-assisted closure)] were performed, but the drainage persisted. Viscum album extract (Helixor-M) was then injected through the drain. The dose of Viscum album extract was increased while being cautious of its adverse effects, such as nausea, vomiting, erythema, induration at the injection site, and flu-like symptoms. The injection was effective in stopping the drainage and the patient's condition improved, without recurrence. The patient was discharged on the 64th postoperative day without any further complications. Our results suggest that treatment of thoracic duct injury after neck surgery with Viscum album extract (Helixor-M) may be a novel, less invasive alternative approach to treat cases resistant to standard treatments.
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Affiliation(s)
- Chai-Won Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea. 271, Cheonbo-ro, Uijeongbu-si, Gyenggi-do, Republic of Korea
| | - Jeong-Soo Kim
- Department of Surgery, Seoul St. Mary's Hospital, college of Medicine, The Catholic University of Korea. 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Ae-Hee Lee
- General Surgery Unit, Uijeongbu St. Mary's Hospital, college of Medicine, The Catholic University of Korea. 271, Cheonbo-ro, Uijeongbu-si, Gyenggi-do, Republic of Korea
| | - Yong-Seok Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea. 271, Cheonbo-ro, Uijeongbu-si, Gyenggi-do, Republic of Korea
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9
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Molena E, King E, Davies-Husband C. Octreotide versus oral dietary modification for the treatment of chylous fistula following neck dissection: A systematic review and meta-analysis. Clin Otolaryngol 2021; 46:474-484. [PMID: 33342047 DOI: 10.1111/coa.13700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/06/2020] [Indexed: 12/17/2022]
Abstract
AIMS Chylous fistula following neck surgery is a rare, but significant complication. Currently, there is no standardised treatment, which may comprise pressure dressings, oral dietary modification (ODM), surgery or a combination of such measures. Octreotide is a somatostatin analogue that has gained popularity in the management of cervical chyle leaks. The effectiveness of octreotide compared with ODM is unclear. We provide a comprehensive, systematic review of the literature pertaining to the management of chylous fistulae, comparing both treatment strategies. METHODS The bibliographic databases MEDLINE, Cochrane, PubMed, EMBASE and Google Scholar were searched from inception to October 2019. Search terms included (chyle [title/abstract]) OR (chylous [title/abstract]) AND (fistula [title/abstract]) OR (fistulae [title/abstract]) OR (leak [title/abstract]) AND (neck [title/abstract]) OR (dissection [title/abstract]). The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Risk of bias was assessed using guidelines from the Joanna Briggs Institute. Outcome measures included the proportion of chylous fistulae that spontaneously resolved without the need for surgery and time taken until resolution, for both DM and octreotide, respectively. RESULTS The primary search identified 20 articles for review, comprising 313 patients. Two studies were suitable for pooled analysis. There was no statistically significant difference in the time taken for chylous fistula to resolve between groups (octreotide 10.0 days; ODM 12.0 days; P = .38). The overall rate of resolution was 89.6% and 81.5%, respectively (P = .25). Surgery was highly effective in cases failing to resolve following intervention with either method (96% [53/55] patients). CONCLUSION The use of octreotide for chylous fistula following neck dissection surgery is associated with a high rate of spontaneous resolution. However, significant heterogeneity, bias and concurrent use of ODM/TPN for patients in studies investigating octreotide precludes universal recommendation at this time. Further research in the form of randomised controlled trials is required to establish an independent treatment effect.
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Affiliation(s)
- Emma Molena
- ENT Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Emma King
- Cancer sciences, University of Southampton, Southampton, UK
| | - Cameron Davies-Husband
- ENT Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,ENT Department, Queen Victoria Hospital Head and Neck Unit, East Grinstead, UK
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Klug T, Sebelik M, Shires CB. Chyloma formation after anterior cervical disc fusion. Clin Case Rep 2020; 8:2721-2724. [PMID: 33363812 PMCID: PMC7752606 DOI: 10.1002/ccr3.3274] [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: 06/05/2020] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 11/09/2022] Open
Abstract
Chyle leak from iatrogenic thoracic duct injury is a rare but serious complication of head and neck surgery. The chyloma in this case took months to recognize and required open thoracic ligation. He fully recovered.
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Yang YH, Park SY, Kim DJ. Chyle Leakage after Esophageal Cancer Surgery. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:191-199. [PMID: 32793451 PMCID: PMC7409880 DOI: 10.5090/kjtcs.2020.53.4.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
Surgeons recommend dissecting lymph nodes in the thorax, abdomen, and neck during surgery for esophageal cancer because of the possibility of metastasis to the lymph nodes in those areas through the lymphatic plexus of the esophageal submucosal layer. Extensive lymph node dissection is essential for accurate staging and is thought to improve survival. However, it can result in several complications, including chyle leakage, which refers to continuous lymphatic fluid leakage and can occur in the thorax, abdomen, and neck. Malnutrition, fluid imbalance, and immune compromise may result from chyle leakage, which can be potentially life-threatening if it persists. Therefore, various treatment methods, including conservative treatment, pharmacological treatment such as octreotide infusion, and interventions such as thoracic duct embolization and surgical thoracic duct ligation, have been applied. In this article, the risk factors, diagnosis, and treatment methods of chyle leakage after esophagectomy are reviewed.
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Affiliation(s)
- Young Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
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12
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Brito C, Vilela P. Near infra-red fluorescence-guidance for percutaneous sclerotherapy of thoracic duct leak. Am J Otolaryngol 2020; 41:102463. [PMID: 32229044 DOI: 10.1016/j.amjoto.2020.102463] [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: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
Treatment of thoracic duct leaks can be very challenging. Intractable chlye leaks may require image-guided methods to increase the likelihood of treatment success. Near infra-red fluorescence is an easy-to-use nonionizing imaging method that has been described to detect thoracic duct leaks in open surgery or thoracoscopic interventions, yet no application to percutaneous sclerotherapy has been described. The authors suggest near infra-red fluorescence as a feasible and useful tool to guide percutaneous sclerotherapy.
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13
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Iwai T, Oebisu N, Hoshi M, Orita K, Yamamoto A, Hamamoto S, Kageyama K, Nakamura H. Promising abscopal effect of combination therapy with thermal tumour ablation and intratumoural OK-432 injection in the rat osteosarcoma model. Sci Rep 2020; 10:9679. [PMID: 32541941 PMCID: PMC7296025 DOI: 10.1038/s41598-020-66934-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/01/2020] [Indexed: 02/06/2023] Open
Abstract
Treatment options for metastatic osteosarcoma are limited. The present study aimed to evaluate whether radiofrequency ablation (RFA) combined with intratumoural OK-432 injection induces systemic anti-tumour immunity in rat osteosarcoma model. Eighty of 145 rats were assigned to four groups to evaluate overall survival and tumour size: control (no treatment), RFA-only, OK-432, and RFA-OK-432. The remaining 65 were assigned for histological examination. Maximum diameters of tibial and lung tumours were determined. Tumour samples were histologically examined using haematoxylin-eosin and immunohistochemical staining. Overall survival was significantly prolonged in the RFA-OK-432 group compared to the RFA-only and OK-432 groups. Only rats in the RFA-OK-432 group exhibited significant decreases in maximum tumour diameter after treatment. Ki-67-positive tumour cells in the RFA-OK-432 group were significantly stained negative on immunohistochemical analysis as opposed to those in the RFA-only and OK-432 groups. The number of CD11c+, OX-62+, CD4+, and CD8 + cells significantly increased in the RFA-OK-432 group compared to the RFA-only group. RFA with intratumoural OK-432 injection resulted in distant tumour suppression, prolonged survival, and increased dendritic cells, cytotoxic T cells, IFN-γ, and TNF-α, whereas RFA or OK-432 alone did not produce this effect. This combination may induce an abscopal effect in human osteosarcoma.
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Affiliation(s)
- Tadashi Iwai
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
| | - Naoto Oebisu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Kumi Orita
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Akira Yamamoto
- Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Shinichi Hamamoto
- Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Ken Kageyama
- Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
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Lindenblatt N, Puippe G, Broglie MA, Giovanoli P, Grünherz L. Lymphovenous Anastomosis for the Treatment of Thoracic Duct Lesion: A Case Report and Systematic Review of Literature. Ann Plast Surg 2020; 84:402-408. [PMID: 31800553 DOI: 10.1097/sap.0000000000002108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chylous leak is an uncommon complication after head and neck surgery and typically results from a lesion of the thoracic duct (TD). Beside conservative treatment, different minimally invasive and surgical procedures exist, of which almost all lead to a total closure of the TD. METHODS We report on a rare case of microsurgical lymphovenous anastomosis to treat a TD lesion. An additional systematic review on surgical procedures to treat TD lesions with special attention to lymphovenous anastomoses was performed according to the PRISMA guidelines. RESULTS A 52-year-old patient with a chylous fistula after modified radical neck dissection was successfully treated by a lymphovenous anastomosis of the TD and external jugular vein with additional coverage by sternocleidomastoid muscle flap. The patient showed a complete resolution of chylous leak with an uneventful postoperative course.The systematic search of literature yielded 684 articles with 4 case reports on lymphovenous anastomosis in chylous leak with a high success rate. Other surgical techniques include transcervical, thoracoscopic, or video-assisted thoracoscopic TD ligation, either alone or combined with a local muscle flap. CONCLUSIONS Lymphovenous anastomosis of the TD is a feasible and safe technique allowing for treatment of cervical TD lesions, especially if minimally invasive procedures fail. Compared with other techniques, lymphatic circulation can successfully be maintained.
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Affiliation(s)
| | | | - Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
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15
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Pointer DT, Durgan DM, Kis B, Khakpour N, Kiluk JV. High-output chyle leak after breast-conserving surgery and sentinel lymph node biopsy. Breast J 2019; 26:514-516. [PMID: 31495018 DOI: 10.1111/tbj.13533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 12/27/2022]
Abstract
Postoperative chyle leak is an exceedingly rare complication following breast and axillary surgery. We present the first described case of chyle leak following breast-conserving surgery and sentinel lymph node biopsy. Management should begin with appropriated conservative measures aimed at reduction of lymph production and flow. Intervention is warranted when conservative strategies fail and include sclerotherapy, lymphangiography, embolization, and surgery. Breast surgeons should be mindful of this potential complication when operating in the axilla and be familiar with its stepwise management.
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Affiliation(s)
- David T Pointer
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida
| | - Diane M Durgan
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida
| | - Bela Kis
- Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida
| | - Nazanin Khakpour
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida
| | - John V Kiluk
- Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida
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16
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Management of High-Output Chyle Leak after Harvesting of Vascularized Supraclavicular Lymph Nodes. Plast Reconstr Surg 2019; 143:1251-1256. [PMID: 30676510 DOI: 10.1097/prs.0000000000005433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Vascularized lymph node transfer is a physiologic microsurgical technique used for the treatment of lymphedema. As vascularized lymph node transfer is becoming more common, it is essential that one is aware of all potential complications associated with vascularized lymph node transfer and know how to avoid and manage them when they do occur. The authors recently encountered a complication after supraclavicular vascularized lymph node transfer that has not been previously reported. A patient developed a recalcitrant high-output (>500 ml/day) chyle leak in the neck donor site after supraclavicular vascularized lymph node transfer harvest. In this article, the authors share their experience with massive chyle leak and review the management strategies of how to effectively avoid and treat this potentially dangerous complication. This review of a previously unreported complication of supraclavicular vascularized lymph node transfer is timely and important, as this procedure is increasingly being offered to patients, and surgeons performing these procedures should be familiar with effectively managing this potentially dangerous complication. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.
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17
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Chakedis J, Phay JE. ASO Author Reflections: Identification of the Thoracic Duct using Indocyanine Green During Cervical Lymphadenectomy. Ann Surg Oncol 2018; 25:3718. [DOI: 10.1245/s10434-018-6709-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 01/25/2023]
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18
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Downey C, O'Neill D, Lee M, Donnelly M, Mullett H. Chylous-Related Complications Following Surgical Management of Clavicular Fractures: A Report of Two Cases. JBJS Case Connect 2018; 8:e61. [PMID: 30095470 DOI: 10.2106/jbjs.cc.17.00260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We treated 2 patients with chylous-related complications following open reduction and internal fixation (ORIF) of the clavicle. These complications were of unknown etiology; 1 was treated with percutaneous injection of a sclerosing agent, while the other was treated with ligation of the thoracic duct. CONCLUSION A chyle leak is more commonly seen with upper gastrointestinal, thoracic, and head and neck surgery. This complication potentially carries a substantial rate of morbidity. We report the successful management of 2 patients with difficult postoperative chylous-related complications following ORIF of the clavicle.
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Affiliation(s)
- Colum Downey
- Departments of Orthopaedics (C.D., M.D., and H.M.), and Radiology (D.O'N. and M.L.), Beaumont Hospital, Dublin, Ireland
| | - Damien O'Neill
- Departments of Orthopaedics (C.D., M.D., and H.M.), and Radiology (D.O'N. and M.L.), Beaumont Hospital, Dublin, Ireland
| | - Michael Lee
- Departments of Orthopaedics (C.D., M.D., and H.M.), and Radiology (D.O'N. and M.L.), Beaumont Hospital, Dublin, Ireland
| | - Michael Donnelly
- Departments of Orthopaedics (C.D., M.D., and H.M.), and Radiology (D.O'N. and M.L.), Beaumont Hospital, Dublin, Ireland
| | - Hannan Mullett
- Departments of Orthopaedics (C.D., M.D., and H.M.), and Radiology (D.O'N. and M.L.), Beaumont Hospital, Dublin, Ireland
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19
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Chakedis J, Shirley LA, Terando AM, Skoracki R, Phay JE. Identification of the Thoracic Duct Using Indocyanine Green During Cervical Lymphadenectomy. Ann Surg Oncol 2018; 25:3711-3717. [PMID: 30076554 DOI: 10.1245/s10434-018-6690-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Injury to the thoracic duct (TD) is the most common complication after a left lateral neck dissection, and it carries a high degree of morbidity. Currently, no routine diagnostic imaging is used to assist with TD identification intraoperatively. This report describes the first clinical experience with lymphangiography using indocyanine green (ICG) during lateral neck dissections. METHODS In six patients undergoing left lateral neck dissection (levels 2-4) for either thyroid cancer or melanoma, 2.5-5 mg of ICG was injected in the dorsum of the left foot 15 min before imaging. Intraoperative imaging was performed with a hand-held near infrared (NIR) camera (Hamamatsu, PDE-Neo, Hamamatsu City, Japan). RESULTS In five patients, the TD was visualized using NIR fluorescence, with a time of 15-90 min from injection to identification. Imaging was optimized by positioning the camera at the angle of the mandible and pointing into the space below the clavicle. No adverse reactions from the ICG injection occurred, and the time required for imaging was 5-10 min. No intraoperative TD injury was identified, and no chyle leak occurred postoperatively. For the one patient in whom the TD was not identified, it is unclear whether this was related to the timing of the injection or to duct obliteration from a prior dissection. CONCLUSION This is the first described application of ICG lymphangiography to identify the thoracic duct during left lateral neck dissection. Identification of TD with ICG is technically feasible, simple to perform with NIR imaging, and safe, making it a potential important adjunct for the surgeon.
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Affiliation(s)
- Jeffery Chakedis
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Lawrence A Shirley
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Alicia M Terando
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Roman Skoracki
- Division of Oncologic Plastic Surgery, Department of Plastic Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - John E Phay
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
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20
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Hong YT, Hong KH. Identification of lymphatic channels in the tracheoesophageal groove during central neck dissection for thyroid cancer. Head Neck 2018; 40:E87-E90. [PMID: 30051536 DOI: 10.1002/hed.25125] [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: 07/22/2017] [Revised: 11/17/2017] [Accepted: 01/26/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Chyle leakage after central neck dissection for thyroid carcinoma is an extremely rare condition. We investigated chyle leakage in patients with thyroidectomy and central neck dissection. METHODS We experienced 3 cases of chyle leakage. The patterns of lymphatic drainage from the central neck to the lateral neck (supraclavicular fossa) were reviewed. The amount and duration of chyle leakage were measured in patients with postoperative chyle leakages. RESULTS The lymphatic channels were found in 2 cases during central neck dissection on the tracheoesophageal groove. One case did not show chyle leakage and ducts during surgery but showed chyle leakage after surgery. CONCLUSION Chyle leakage can occur after thyroidectomy with central neck dissection. There have been no reports on identification of lymphatic channels during central neck dissection. This finding will aid in the recognition and treatment of this uncommon complication during or after central neck dissection in patients with thyroid cancer.
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Affiliation(s)
- Yong Tae Hong
- Department of Otolaryngology - Head and Neck Surgery, Research Institute for Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 560-182, Korea
| | - Ki Hwan Hong
- Department of Otolaryngology - Head and Neck Surgery, Research Institute for Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk, 560-182, Korea
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21
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Huang CL, Chang H, Lee JC, Dai MS. Gefitinib Leads to Complete Resolution of Postoperative Cervical Chyloma and Chylothorax in a Lung Cancer Patient. TUMORI JOURNAL 2018; 100:e49-51. [DOI: 10.1177/030089161410000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cervical chyloma is a not uncommon complication after neck surgery, especially following diagnostic excision of supraclavicular lymph nodes. Conservative treatment remains the standard approach but is inevitably distressful. We describe the case of a 60-year-old Asian woman who was diagnosed as having adenocarcinoma of the lung with cervical and supraclavicular node involvement. She developed persistent cervical chyle leak after excisional biopsy of the supraclavicular nodes and proved refractory to all management. Subsequent gefitinib therapy led to rapid resolution of chyloma and tumor regression. This case provided a unique experience of managing intractable postoperative chyloma in a cancer patient.
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Affiliation(s)
- Chia-Luen Huang
- Hematology/Oncology Division, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung Chang
- Thoracic Surgery Division, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jih-Chin Lee
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Shen Dai
- Hematology/Oncology Division, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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22
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Chan JYW, Wong STS, Wei WI. Real time indocyanin green near infrared lymphangiography for the reduction of drainage volume after neck dissection. Oral Oncol 2018; 78:52-55. [PMID: 29496058 DOI: 10.1016/j.oraloncology.2018.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/20/2017] [Accepted: 01/09/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND To investigate the role of indocyanine green (ICG) lymphangiography in the reduction of drainage after neck dissection. METHODS Patients with oral cavity squamous cell carcinoma were randomized into Group A (study group) and Group B (control). In the study group, upon the completion of neck dissection, a total of 2.5 mg of ICG was injected submucosally at the four quadrants around the tumour. Another 2.5 mg of ICG was injected subdermally in the groin bilaterally. The neck was screened using Near Infrared fluorescence. The presence of lymphatic leakage was noted and plicated with silk stitches. The total drainage volume of post-operative day 1, day 2 and the total accumulated volume until drain removal was measured. RESULTS Twenty-two patients (Group A, n = 12; Group B, n = 10) were recruited. All patients in Group A had at least one site of lymphatic leakage identified. One patient in Group B developed chylous fistula and was excluded from analysis. The mean total drain output for day 1 and 2 after surgery, as well as the mean total output before drain removal, were significantly lower in Group A (22.4 ml vs. 86.2 ml [p = .02]; 14.2 ml vs. 72.8 ml [p = .02]; and 58.4 ml vs. 392 ml [p = .01], respectively), allowing earlier drain removal (2.2 days vs. 7.2 days, p = .02). CONCLUSIONS Intra-operative ICG lymphangiography is useful in the reduction of drainage volume after neck dissection for caners in the head and neck region.
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Affiliation(s)
- Jimmy Yu Wai Chan
- University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong Special Administrative Region.
| | - Stanley Thian Sze Wong
- University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong Special Administrative Region
| | - William Ignace Wei
- University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong Special Administrative Region
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23
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Park I, Her N, Choe JH, Kim JS, Kim JH. Management of chyle leakage after thyroidectomy, cervical lymph node dissection, in patients with thyroid cancer. Head Neck 2017; 40:7-15. [DOI: 10.1002/hed.24852] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 01/30/2017] [Accepted: 04/25/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Inhye Park
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Nayoon Her
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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24
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张 永, 黎 志, 陈 飞, 汪 红, 李 强. [Comparison of postoperative drainage and systemic trauma response after endoscopic and traditional near total thyroidectomy]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1364-1369. [PMID: 29070467 PMCID: PMC6743955 DOI: 10.3969/j.issn.1673-4254.2017.10.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the difference of postoperative drainage and systemic trauma response between endoscopic and traditional near total thyroidectomy to provide the basis for selecting appropriate operative methods. METHODS In this prospective clinical controlled study, 80 patientsscheduled for near total bilateral thyroidectomy for the first time were divided equally into endoscopic surgery group (group A) and open surgery group (group B). The total drainage volume after operation, postoperative extubation time, and postoperative daily drainage volume were recorded after the operation. The contents of triglyceride (TG) and total protein (TP) were determined in the postoperative drainage fluid onthe first day. The levels of interleukin 6 (IL6), high sensitive C reactive protein (HSCRP), alpha 1 acid glycoprotein (AAG), ceruloplasmin (CER) and haptoglobin (HPT) in venous blood were tested before the operation and on the first day after surgery. RESULTS Compared with those in group B, the postoperative drainage volumein group Aincreased significantly (P=0.000) and the postoperative extubation time was significantly prolonged (P=0.000); the mean postoperative daily drainage volume was significantly larger ingroup A than in group B (P=0.000) and tended to decrease with time in both groups. There was no significant difference in the content of triglycerideortotal protein in the drainage fluid between the two groups on the first day after operation (P=0.429 and 0.324, respectively). In both groups, the contents of AAG, ceruloplasmin and haptoglobin on the first postoperative day were all similar with those measurement before operation (P>0.05), but significant variations occurred in the levels of IL6 and HSCRP on the first postoperative day (P=0.000). The serum levels of IL?6 or HS?CRP did not differ significantly between the two groups on the first day after operation (P=0.054 and 0.066, respectively). CONCLUSION Compared with open surgery, endoscopic near total bilateral thyroidectomyis associated with an increased the volume of postoperative drainage and a prolonged time of extubationbut not an increased systemic trauma response. Therefore, endoscopic surgery can serve as one of the routine options for patients who are concerned with neckscars resulting from open surgeries.
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Affiliation(s)
- 永泉 张
- />南方医科大学珠江医院普通外科, 广东 广州 510282Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 志超 黎
- />南方医科大学珠江医院普通外科, 广东 广州 510282Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 飞 陈
- />南方医科大学珠江医院普通外科, 广东 广州 510282Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 红娟 汪
- />南方医科大学珠江医院普通外科, 广东 广州 510282Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 强 李
- />南方医科大学珠江医院普通外科, 广东 广州 510282Department of General surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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25
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Pena I, Clayman GL, Grubbs EG, Bergeron JM, Waguespack SG, Cabanillas ME, Dadu R, Hu MI, Fellman BM, Li Y, Gross ND, Lai SY, Sturgis EM, Zafereo ME. Management of the lateral neck compartment in patients with sporadic medullary thyroid cancer. Head Neck 2017; 40:79-85. [DOI: 10.1002/hed.24969] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/19/2017] [Accepted: 09/03/2017] [Indexed: 11/07/2022] Open
Affiliation(s)
- Israel Pena
- Department of Head and Neck Surgery; MD Anderson Cancer Center; Houston Texas
| | - Gary L. Clayman
- Department of Head and Neck Surgery; MD Anderson Cancer Center; Houston Texas
| | | | - Jeffrey M. Bergeron
- Department of Head and Neck Surgery; MD Anderson Cancer Center; Houston Texas
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders; MD Anderson Cancer Center; Houston Texas
| | - Maria E. Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders; MD Anderson Cancer Center; Houston Texas
| | - Ramona Dadu
- Department of Endocrine Neoplasia and Hormonal Disorders; MD Anderson Cancer Center; Houston Texas
| | - Mimi I. Hu
- Department of Endocrine Neoplasia and Hormonal Disorders; MD Anderson Cancer Center; Houston Texas
| | - Bryan M. Fellman
- Department of Biostatistics; MD Anderson Cancer Center; Houston Texas
| | - Yisheng Li
- Department of Biostatistics; MD Anderson Cancer Center; Houston Texas
| | - Neil D. Gross
- Department of Head and Neck Surgery; MD Anderson Cancer Center; Houston Texas
| | - Stephen Y. Lai
- Department of Head and Neck Surgery; MD Anderson Cancer Center; Houston Texas
| | - Erich M. Sturgis
- Department of Head and Neck Surgery; MD Anderson Cancer Center; Houston Texas
| | - Mark E. Zafereo
- Department of Head and Neck Surgery; MD Anderson Cancer Center; Houston Texas
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26
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Lombardi D, Accorona R, Paderno A, Cappelli C, Nicolai P. Morbidity of central neck dissection for papillary thyroid cancer. Gland Surg 2017; 6:492-500. [PMID: 29142840 DOI: 10.21037/gs.2017.05.07] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Thyroid cancer has a very well-known propensity for nodal involvement, either in the central and lateral neck compartments. Neck dissection addressing the central compartment may be performed with an elective or therapeutic intent, the former concomitantly to a thyroidectomy whereas the latter may be accomplished also as a revision procedure for recurrent disease. In this paper complications of central compartment neck dissection will be described, analyzing separately primary and revision procedures.
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Affiliation(s)
- Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Remo Accorona
- Department of Otorhinolaryngology - Head and Neck Surgery, Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Carlo Cappelli
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
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27
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Delaney SW, Shi H, Shokrani A, Sinha UK. Management of Chyle Leak after Head and Neck Surgery: Review of Current Treatment Strategies. Int J Otolaryngol 2017; 2017:8362874. [PMID: 28203252 PMCID: PMC5288539 DOI: 10.1155/2017/8362874] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/07/2016] [Indexed: 11/17/2022] Open
Abstract
Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body. Chyle extravasation can result in delayed wound healing, dehydration, malnutrition, electrolyte disturbances, and immunosuppression. Prompt identification and treatment of a chyle leak are essential for optimal surgical outcome. In this article we will review the current treatment options for iatrogenic cervical chyle leaks.
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Affiliation(s)
- Sean W. Delaney
- Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar St, Suite 204Q, Los Angeles, CA 90033, USA
| | - Haoran Shi
- Department of Biochemistry and Molecular Biology, University of Southern California, Los Angeles, CA, USA
| | - Alireza Shokrani
- Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar St, Suite 204Q, Los Angeles, CA 90033, USA
| | - Uttam K. Sinha
- Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine, University of Southern California, 1540 Alcazar St, Suite 204Q, Los Angeles, CA 90033, USA
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28
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Lok HT, Liu SYW, Wong SKH, Ng EKW. Chyle leak: An unusual complication after total thyroidectomy and central neck dissection. SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hon-Ting Lok
- Department of Surgery, Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Shirley Yuk-Wah Liu
- Department of Surgery, Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Simon Kin-Hung Wong
- Department of Surgery, Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Enders Kwok-Wai Ng
- Department of Surgery, Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
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29
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Zou M, Reid D, Ravichandran D. Neck swelling after thyroidectomy: not always a haematoma. BMJ Case Rep 2015; 2015:bcr-2015-211758. [PMID: 26564112 DOI: 10.1136/bcr-2015-211758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a patient who returned with a neck swelling 6 days following thyroidectomy and central neck compartment lymphadenectomy for suspected thyroid carcinoma. The initial clinical suspicion pointed to a haematoma, but a needle aspiration showed chyle. Chyle leak is a rare complication of thyroid surgery. In the described case, this was successfully managed conservatively with repeated aspirations and a low-fat diet. We discuss the aetiology, presentation and management of this complication.
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Affiliation(s)
- Maggie Zou
- Epsom and St Helier University Hospital, London, UK
| | - Diane Reid
- Luton & Dunstable University Hospital, Luton, UK
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30
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Wei T, Liu F, Li Z, Gong Y, Zhu J. Novel Management of Intractable Cervical Chylous Fistula with Local Application of Pseudomonas aeruginosa Injection. Otolaryngol Head Neck Surg 2015; 153:561-5. [PMID: 26002958 DOI: 10.1177/0194599815584917] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/10/2015] [Indexed: 02/05/2023]
Abstract
Objective Cervical chylous fistula is an uncommon complication after neck dissection, but it might lead to some serious clinical outcomes. Although most cervical chylous fistulas can heal in a few days with standard treatments, some can be intractable. In this study, we describe a new method with local application of Pseudomonas aeruginosa injection for intractable cervical chylous fistula. Study Design Case series with chart review. Setting West China Hospital, Sichuan University, Chengdu, China. Subjects and Methods The charts of 18 patients who were treated with P aeruginosa injection (PAI) for intractable cervical chylous fistula were retrospectively reviewed. Results All patients were successfully treated with PAI. Mild fever (temperature, <38°C) occurred in 9 patients, moderate fever (38°C-39°C) in 4 patients, and severe fever (>39°C) in 5 patients. All patients had mild to severe neck pain. Conclusions Local application of PAI is an effective method for the treatment of intractable cervical chylous fistula, of which the most common side effects are transient fever and local pain.
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Affiliation(s)
- Tao Wei
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Feng Liu
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhihui Li
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanping Gong
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingqiang Zhu
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Steven BR, Carey S. Nutritional management in patients with chyle leakage: a systematic review. Eur J Clin Nutr 2015; 69:776-80. [DOI: 10.1038/ejcn.2015.48] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 08/24/2014] [Accepted: 01/23/2015] [Indexed: 01/10/2023]
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Jain A, Singh SN, Singhal P, Sharma MP, Grover M. A prospective study on the role of Octreotide in management of chyle fistula neck. Laryngoscope 2015; 125:1624-7. [DOI: 10.1002/lary.25171] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 11/24/2014] [Accepted: 12/29/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Avani Jain
- Department of Otolaryngology (ENT); Sawai Man Singh Medical College and Attached Group of Hospitals; Jaipur Rajasthan India
| | - Shashank Nath Singh
- Department of Otolaryngology (ENT); Sawai Man Singh Medical College and Attached Group of Hospitals; Jaipur Rajasthan India
| | - Pawan Singhal
- Department of Otolaryngology (ENT); Sawai Man Singh Medical College and Attached Group of Hospitals; Jaipur Rajasthan India
| | - Man Prakash Sharma
- Department of Otolaryngology (ENT); Sawai Man Singh Medical College and Attached Group of Hospitals; Jaipur Rajasthan India
| | - Mohnish Grover
- Department of Otolaryngology (ENT); Sawai Man Singh Medical College and Attached Group of Hospitals; Jaipur Rajasthan India
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Chyle leak: a rare complication post-hemithyroidectomy. case report and review of literature. Otolaryngol Pol 2014; 68:204-7. [PMID: 24981304 DOI: 10.1016/j.otpol.2014.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 03/27/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Thyroidectomy is one of the common neck surgeries. Well recognized complications include postoperative bleeding, hypocalcaemia and recurrent laryngeal nerve injury. Chyle leak post-thyroidectomy is extremely rare. Most of the reported cases have had a complete central compartment neck dissection. METHODS AND RESULTS This is a case report of a patient who suffered from chyle leak after a left hemithyroidectomy without a complete central compartment neck dissection. The patient was managed conservatively with low fat diet and observation. A protocol for approaching thyroid patients with chyle leak is proposed based on a comprehensive literature review. CONCLUSION Chyle leak post-thyroidectomy for a benign disease is a very rare complication. Nevertheless, head and neck surgeons should consider it in the differential diagnosis of neck swelling post-thyroidectomy.
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Tavares MR, Cruz JASD, Waisberg DR, Toledo SPDA, Takeda FR, Cernea CR, Capelozzi VL, Brandão LG. Lymph node distribution in the central compartment of the neck: an anatomic study. Head Neck 2014; 36:1425-30. [PMID: 24038585 DOI: 10.1002/hed.23469] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/09/2013] [Accepted: 08/14/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Dissection of the central compartment of the neck (CCN) is performed for proven or suspected lymph node metastases of thyroid carcinoma. During this procedure, the recurrent laryngeal nerves and the parathyroid glands are at risk. The purpose of this study was to determine the anatomic distribution of the lymph nodes in the CCN. METHODS The anatomic distribution of the lymph nodes in the CCN was studied by dissection of 30 fresh cadavers. The soft tissue between the cricoid cartilage and the innominate vein, carotid arteries, and prevertebral fascia was removed and divided according to CCN sublevels. Nodules were identified by palpation in the specimen and sent for pathological examination. RESULTS Three to 44 (18.5 ± 10.29) nodules were identified macroscopically. Two to 42 nodules were confirmed as lymph nodes after microscopic examination. The lymph node distribution was as follows: precricoid: 0 to 2 (0.9 ± 0.72); pretracheal: 1 of 35 (12.4 ± 8.19); lateral to the right recurrent laryngeal nerve (RLN): 0 to 11 (3.4 ± 2.34); and lateral to the left: 0 to 4 (1.7 ± 1.30). Twenty-six parathyroid glands were removed by 14 dissections. The innominate vein was found at 15 mm above the superior border of the clavicles to 35 mm below on the left side of the neck and 5 to 45 mm on the right side. CONCLUSION The number of confirmed lymph nodes in the central neck varied from 2 to 42. Sixty-seven percent of the lymph nodes were in the pretracheal sublevel. There was no division between level VI and VII lymph nodes. Additionally, the innominate vein was found to be from 15 mm above the superior border of the clavicles to 35 mm below on the left side of the neck and 5 to 45 mm on the right side. Parathyroid glands were identified to be far away from the thyroid gland.
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Affiliation(s)
- Marcos Roberto Tavares
- Department of Head and Neck Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
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Affiliation(s)
- Kang Dae Lee
- Department of Otolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Hyoung Shin Lee
- Department of Otolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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Abstract
PURPOSE OF REVIEW The present review is focused on the management of lymphatic, chylous, and thoracic duct lesions following head and neck surgery, with particular attention to these complications after neck dissection. Postoperative scenarios may include chylous fistula, chylothorax, chylomediastinum, chylopericardium, lymphocele, persistent lymphorrhea, and secondary lymphedema. RECENT FINDINGS There is a paucity of literature on the treatment of lymphatic, chylous, and thoracic duct injuries following head and neck surgery; however, this review suggests that the most appropriate treatment should include both conservative and surgical approaches. Nonsurgical options consist of low-fat diet with medium-chain triglycerides, total parenteral nutrition, careful monitoring of fluid and electrolytes, drainage of the leakage, somatostatin analogs such as octreotide, and negative-pressure wound therapy. On the other hand, surgical management includes therapeutic percutaneous lymphography-guided thoracic duct cannulation and embolization, thoracic duct ligation, excision and imbrication of leaking lymphatics, chylous fistula surgical/microsurgical repair, fistula closure by locoregional flaps, video-assisted thoracoscopic surgery, thoracotomy, pleurodesis and decortication, pericardial 'window', and pleura-venous/pleura-peritoneal shunts. In addition, single or, preferably, multiple lymphovenous anastomoses may be taken into account. SUMMARY The various possible clinical presentations of such challenging lymphatic, chylous, and thoracic duct injuries require an appropriate multidisciplinary approach by experienced teams. Primary prevention of these complications can be achieved through adequate surgical planning to minimize lesions, including structured and thorough patient assessment, and centralization of resources and teams.
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Lang BHH, Wong CKH. A cost-minimization analysis comparing total thyroidectomy alone and total thyroidectomy with prophylactic central neck dissection in clinically nodal-negative papillary thyroid carcinoma. Ann Surg Oncol 2013; 21:416-25. [PMID: 23982258 DOI: 10.1245/s10434-013-3234-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Total thyroidectomy (TT) with prophylactic central neck dissection (pCND) remains controversial for clinically nodal-negative (cN0) papillary thyroid carcinoma (PTC), and the issue of cost rarely has been examined. We evaluated whether pCND at the time of TT is more cost-saving than TT alone in the medium- to long-term. METHODS For a hypothetical group of 50-year-old females with a 1.5-cm cN0 PTC, a decision-tree model using TreeAge Software was developed to simulate outcomes and compare the 20-year accumulative direct cost between TT alone and TT+pCND strategies. Baseline values and ranges were determined from a systematic review of the literature. Sensitivity analyses were conducted to test model strength. Cost estimate of surgical procedures, complications, and radioiodine (RAI) ablation was based on government gazette. RESULTS The cost accrued per patient for the primary operation under TT alone and TT+pCND strategies were USD 6,702.81 and USD 10,062.35, respectively, whereas the cost for the reoperative procedure were USD 12,981.40 and USD 12,509.09, respectively. The 20-year accumulative cost for TT alone and TT+pCND strategies were USD 19,888.36 and USD 22,760.86, respectively. The incremental cost per patient was USD 2,872.50. In the univariate and bivariate sensitivity analyses, no change in conclusion was seen by varying the rates of complications, annualized locoregional recurrences and RAI, or by extending the model to 50 years. CONCLUSIONS From a pure economic institution's perspective, TT+pCND is more expensive in the medium- and long-term and seems less justified compared with TT alone for cN0 PTC.
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Affiliation(s)
- Brian Hung-Hin Lang
- Division of Endocrine Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China,
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Eid N, Ito Y, Otsuki Y. Thoracic duct relationships to abnormal neurovascular structures in cervicothoracic regions: case study and clinical relevance. Surg Radiol Anat 2013; 35:969-72. [PMID: 23536153 DOI: 10.1007/s00276-013-1111-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 03/19/2013] [Indexed: 12/26/2022]
Abstract
The presence of variant intercostal and bronchial arteries and variable position of left recurrent laryngeal nerve (LRLN) along the course of thoracic duct (TD) may have clinical relevance in various cervicothoracic surgeries.
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Affiliation(s)
- N Eid
- Division of Life Sciences, Department of Anatomy and Cell Biology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan,
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Lee YS, Kim BW, Chang HS, Park CS. Factors predisposing to chyle leakage following thyroid cancer surgery without lateral neck dissection. Head Neck 2012; 35:1149-52. [DOI: 10.1002/hed.23104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2012] [Indexed: 11/11/2022] Open
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Brennan P, Blythe J, Herd M, Habib A, Anand R. The contemporary management of chyle leak following cervical thoracic duct damage. Br J Oral Maxillofac Surg 2012; 50:197-201. [DOI: 10.1016/j.bjoms.2011.02.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/02/2011] [Indexed: 11/25/2022]
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Cernea CR, Hojaij FC, De Carlucci D, Tavares MR, Araújo-Filho VJ, Silva-Filho GBE, Brandão LG. Abdominal compression: a new intraoperative maneuver to detect chyle fistulas during left neck dissections that include level IV. Head Neck 2012; 34:1570-3. [PMID: 22290583 DOI: 10.1002/hed.21956] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Revised: 07/05/2011] [Accepted: 09/06/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Chyle fistulas may occur after left neck dissections that include level IV, due to injury of the thoracic duct or of 1 of its major branches. Despite being unusual, this complication carries substantial postoperative morbidity and even mortality. So far, no effective intraoperative maneuver has been reported to detect this fistula at the end of a neck dissection. In this cohort study, we sought to describe a simple new maneuver, intraoperative abdominal compression, which can effectively help to identify an open major lymphatic duct on level IV at the end of a neck dissection. PATIENTS AND METHODS From March 1989 to September 2010, 206 patients underwent neck dissections involving left level IV, and underwent intraoperative abdominal compression. There were 119 men and 87 women, with ages ranging from 18 to 81 years (median, 52 years). One hundred forty-four patients had squamous cell carcinomas, 54 had thyroid carcinomas, 5 had malignant melanomas, and 3 had salivary cancers. Distribution by type of left neck dissection was: selective including levels II, III, and IV (73 cases; 35.4%), selective including levels II, III, IV, and V (55 cases; 26.6%), selective including levels I, II, III, and IV (12 cases; 5.8%), modified radical (47 cases; 22.8%), and radical (19 cases; 9.2%). In all cases, at the end of the procedure, the endotracheal tube was temporarily disconnected from the ventilator. Keeping the dissected level IV area under clear visualization, an abdominal compression was performed. At this moment, any detected lymphatic leak was carefully clamped and tied with nonabsorbable sutures. After ventilating the patient, the intraoperative abdominal compression was repeated to reassure complete occlusion of the lymphatic vessel. RESULTS In 13 cases (6.3%), a chyle leak was detected after performing the intraoperative abdominal compression. All leaks except for 2 were successfully controlled after 1 attempt. In these 2 patients, a patch of muscle and fat tissue was applied with fibrin glue on the top. In 1 of these patients, another chyle leak in a different location was detected only at the second intraoperative abdominal compression, and was also effectively closed. Postoperatively, there were 2 (1%) chyle fistulas, both among these 13 cases, and all were successfully managed with clinical measures only. No fistulas occurred among the remaining 193 patients in whom intraoperative abdominal compression did not demonstrate lymphatic leak. CONCLUSION To our knowledge, this is the first description of a specific maneuver to actively detect a lymphatic fistula at the end of a left neck dissection involving level IV. In this study, intraoperative abdominal compression was able to detect an open lymphatic vessel in 6.3% of the cases, as well as to assure its effective sealing in the remaining 93.7% of the patients. Moreover, no life-threatening high-volume fistula was noted in this study.
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Affiliation(s)
- Claudio R Cernea
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil.
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Wu G, Chang X, Xia Y, Huang W, Koch WM. Prospective randomized trial of high versus low negative pressure suction in management of chyle fistula after neck dissection for metastatic thyroid carcinoma. Head Neck 2011; 34:1711-5. [PMID: 22180331 DOI: 10.1002/hed.21979] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 07/18/2011] [Accepted: 09/08/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Negative pressure drainage has been shown to be an effective treatment of chyle fistula. However, the optimal level of negative pressure has not been determined. We therefore conducted a prospective randomized trial to address this issue. METHODS In all, 21 patients with chyle fistula were randomly assigned to a high negative pressure suction (HNPS) group (-600 mmHg, n = 10) or low negative pressure suction (LNPS) group (-125 mmHg, n = 11). The duration of drain leakage and hospital stay, and the incidence of complications were compared between the 2 groups. RESULTS All patients were successfully treated with conservative management without surgical intervention. The median durations of chyle leakage and hospital stay were significantly shorter in the HNPS group compared with the LNPS group: 4 versus 7 days (p = .0048) and 5 versus 11 days (p = .0107), respectively. CONCLUSIONS Negative suction was demonstrated to be highly effective in the management of chyle fistula, and HNPS appeared to be more efficient than LNPS.
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Affiliation(s)
- Gaosong Wu
- Department of Thyroid Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery 2011; 151:192-8. [PMID: 21497873 DOI: 10.1016/j.surg.2011.02.004] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 02/10/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND In papillary thyroid microcarcinoma (PTMC), regional lymph node metastasis (LNM) is associated with a increased locoregional recurrence rate. Yet, prophylactic central lymph node dissection (CLND) targeting subclinical central LNM continues to be a matter of debate in the treatment of PTMC, which generally carries an excellent prognosis. The aim of our study was to investigate the benefits and risks of prophylactic CLND in patients with clinically node-negative PTMC. METHODS This study included 232 patients who underwent surgery for clinically node-negative PTMC from 1999 to 2006. Of these 232 patients, 113 underwent only total thyroidectomy (TT) and 119 underwent TT in conjunction with prophylactic bilateral CLND (TT with CLND). We then compared serum thyroglobulin (Tg) levels, recurrence rates, and postoperative complications between the 2 groups (TT only and TT with CLND). RESULTS The postoperative stimulated serum Tg level was significantly less in the TT with CLND group than in the TT only group (1.07 vs. 2.24 ng/mL, respectively; P = .022). The stimulated Tg levels in the 2 groups became similar, however, after low-dose radioactive iodine treatment (0.44 ng/mL vs. 0.69 ng/mL, respectively; P = 0.341). There was no significant difference in 3-year locoregional control rates after TT with CLND and TT only (98.3% vs. 96.5%, respectively; P = .368). Although the frequency of permanent hypocalcemia was approximately 3 times greater in the TT with CLND group (5.6%) than in the TT only group (1.8%), this finding did not reach statistical significance. CONCLUSION With prophylactic CLND, the postoperative Tg level can significantly decrease. However, prophylactic CLND is not helpful in decreasing short-term locoregional recurrence in patients with clinically node-negative PTMC. Finally, the risk of permanent hypocalcemia may increase after CLND.
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Affiliation(s)
- Yoon Kyoung So
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea
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Abdul-Aziz D, Tierney HT, Deschler DG. Surgical management of cervical chyloma following parathyroidectomy. Auris Nasus Larynx 2011; 38:528-31. [PMID: 21257276 DOI: 10.1016/j.anl.2010.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/17/2010] [Accepted: 09/21/2010] [Indexed: 11/19/2022]
Abstract
Although rare, chylomas can present as a neck mass, especially in the post-operative setting. Here, we present a case of a persistent cervical chyloma following parathyroidectomy and propose a management algorithm for this clinical entity.
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Affiliation(s)
- Dunia Abdul-Aziz
- Department of Otology and Laryngology, Division of Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, 02114, USA
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Coşkun A, Yildirim M. Somatostatin in medical management of chyle fistula after neck dissection for papillary thyroid carcinoma. Am J Otolaryngol 2010; 31:395-6. [PMID: 20015785 DOI: 10.1016/j.amjoto.2009.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 05/06/2009] [Indexed: 11/28/2022]
Abstract
The use of somastostatin and its analogues in the treatment of chyle fistula is a new approach and has been documented in a few cases. In this study, we present the case of a male patient with chyle fistula that was stopped completely within 24 hours after the somatostatin therapy.
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Affiliation(s)
- Ali Coşkun
- Izmir Teaching and Research Hospital, General Surgery Department, Izmir,Turkey.
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