Management of postoperative chylothorax generally involves nutritional regimens as well as pharmacological and surgical therapies, but a clear consensus has yet to be reached.
Retrospective review of 371 patients who underwent esophagectomy for esophageal cancer was performed. They were patients with squamous cell carcinoma or adenocarcinoma of the esophagus including Siewert type I/II tumor of the esophagogastric junction who underwent subtotal esophagectomy. Of these patients, 19 patients who were diagnosed with chylothorax as a postoperative complication were enrolled in this study.
Conservative treatment achieved cure in 16 patients among 19 patients. The duration of chylothorax tended to be longer in the no-etilefrine group (n = 5) than in the etilefrine group (n = 11) (27.8 vs. 11.6 days; p = 0.078). The 14 patients among 19 patients resected the thoracic duct. Etilefrine was used in 12 of these 14 patients. Among these 12 patients, 3 required surgical treatment and the remaining 9 patients were cured with conservative treatment. The duration of chylothorax was shorter in the conservative treatment group than in the surgical treatment group (11.9 vs. 36.3 days; p = 0.052). In addition, with the use of etilefrine as adjuvant therapy, cure was achieved in 9 patients (75%) without surgical intervention.
The findings of this study suggest that when used concurrently with conventional treatments, etilefrine facilitates early chest tube removal. In addition, post-thoracic duct resection chylothorax, which frequently requires surgical treatment because of the general less effectiveness of conservative treatments, showed high successful rate (75%) to etilefrine treatment.
Bender B, Murthy V, Chamberlain RS. The changing management of chylothorax in the modern era. Eur J Cardiothorac Surg. 2016;249:18–24. CrossRef
Hata T, Kawanishi K, Nagai K, et al. Successful treatment of post-operative chylothorax by etilefrine after esophageal carcinoma resection. Jpn J Gastroenterol Surg. 2013;46:79–84 (in Japanese with English abstract). CrossRef
Ojima T, Nakamori M, Nakamura M, et al. A case of chylothorax appeared after surgery for esophageal cancer cured by administration of octreotide/etilefrine and injection of OK-432 into the pleural cavity. J Jpn Surg Assoc. 2014;75:1547–50 (in Japanese with English abstract). CrossRef
Sobin LH, Gospodarowicz MK, Wittekind C, editors. International union against cancer. Oesophagus including oesophagogastric junction. ‘‘TNM classification of malignant tumours’’. West Sussex: Wiley-Blackwell; 2009. p. 66–72.
Staats BA, Ellefson RD, Budahn LL, et al. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc. 1980;55:700–4. PubMed
Udagawa H, Ueno M, Shinohara H, et al. Should lymph nodes along the thoracic duct be dissected routinely in radical esophagectomy? Esophagus. 2014;11:204–10. CrossRef
Marts BC, Naunheim KS, Fiore AC, et al. Conservative versus surgical management of chylothorax. Am J Surg. 1992;164:534–5. CrossRef
- Effectiveness of etilefrine regimen for chylothorax after esophagectomy with thoracic duct resection
- Springer Japan
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II