World Journal of Endocrine Surgery

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VOLUME 7 , ISSUE 1 ( January-April, 2015 ) > List of Articles

REVIEW ARTICLE

Management of Chyle Leak in the Neck Following Thyroid Cancer Surgery: A Single Center Experience

Deepak Thomas Abraham, Anish Cherian, Mazhuvanchary Jacob Paul

Citation Information : Abraham DT, Cherian A, Paul MJ. Management of Chyle Leak in the Neck Following Thyroid Cancer Surgery: A Single Center Experience. World J Endoc Surg 2015; 7 (1):6-9.

DOI: 10.5005/jp-journals-10002-1156

Published Online: 01-04-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction

Surgery for thyroid cancers often necessitates a neck dissection. This is usually a safe procedure, but can be associated with complications. Chyle leak is one such complication, fortunately rare. There is a dearth of literature with regard to the management of chyle leak in the neck. We present a single center experience in the management of chyle leak in the neck, to improve the understanding of its management.

Materials and methods

A retrospective analysis of patients with thyroid cancer, managed between January 1st 2005 and December 31st 2011, in a single institution was performed. Among these, patients with chyle leak were identified. All pertinent data collected and results analyzed using STATA (v10).

Results

Three hundred and seventy-three/eight hundred and twenty-one (45.4%) patients surgically managed for thyroid cancer underwent a neck dissection. Thoracic duct injury was recog- nized and managed intraoperatively in 20/373 (5.4%) patients. The leak was prevented in the majority (66.6%) of patients in whom a combination of methods were employed. 25/373 (6.7%) patients were diagnosed and managed for chyle leak postoperatively. Seven patients required re-exploration. This included patients with low output chyle leaks who may have settled in a week to 10 days with conservative management. A combination of techniques was successful in the majority (71.4%). The remaining patients were successfully managed conservatively.

Conclusion

We conclude that using a combination of methods to manage thoracic duct injury may be better than using a single modality alone. Early re-exploration was more economical and acceptable for a subset of our patients, as they come from long distances at personal cost.

How to cite this article

Cherian a, Ramakant P, Paul MJ, Abraham DT. Management of Chyle Leak in the Neck Following Thyroid Cancer Surgery: A Single Center Experience. World J Endoc Surg 2015;7(1):6-9.


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  1. The contemporary management of chyle leak following cervical thoracic duct damage. Br J Oral Maxillofac Surg 2012 Apr;50(3):197-201.
  2. Management of chyle leak post neck dissection: a case report and literature review. J Plastic Reconstruct Aesthet Surg 2011 Sep;64(9):e223-230.
  3. Anatomical variations of the cervical portion of the thoracic duct in man. J Anat 1973 May;115(Pt 1):45-52.
  4. Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci 2010 Apr;25(4):541-545.
  5. Management of chylous leakage following neck dissection: case report. J Dent Sci 2008;3(1):57-61.
  6. Systematic management of chyle fistula: the Southwestern experience and review of the literature. Otolaryngology—Head and Neck Surgery 2000 Jan 1;122(1):31-38.
  7. Thoracic duct fistula after thyroid cancer surgery: towards a new treatment? Case Reports in Oncology 2011;4(2):255-259.
  8. Modern management of chylous leak following head and neck surgery: a discussion of percutaneous lymphangiography-guided cannulation and embolization of the thoracic duct. Otolaryngologic Clinics of North America 2008 Dec;41(6):1231-1240.
  9. Chyle fistula management. Otolaryngol Head Neck Surg 1981 Aug;89(4):575-578.
  10. Persistent chyle leak following radical neck dissection: a solution that can be the solution. Annals of the Royal College of Surgeons of England 2005 Sep 1;87(5):379.
  11. Chyle leakage in patients undergoing thyroidectomy plus central neck dissection for differentiated papillary thyroid carcinoma. Ann Surg Oncol 2008 Sep;15(9):2576-2580.
  12. Tetracycline sclerotherapy for chylous fistula following neck dissection. Arch Otolaryngol Head Neck Surg 1986 Jun;112(6):651-653.
  13. Octreotide in the medical management of chyle fistula. Otolaryngology— Head and Neck Surgery 2003 Jun;128(6):910-911.
  14. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg 1998 Jul;66(1):253-254.
  15. Somatostatin analog treatment of a cervical thoracic duct fistula. Head Neck 2002 Aug;24(8):810-813.
  16. High output chyle leak after neck surgery: the role of video-assisted thoracoscopic surgery. Br J Oral Maxillofac Surg 2009 Sep;47(6):478-480.
  17. Thoracoscopic thoracic duct ligation for persistent cervical chyle leak: utility of immediate pathologic confirmation. J Society of Laparoendoscopic Surgeons 2009;13(3):430.
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