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The journal «ONCOSURGERY» 2012, Vol.4, No 4

Chylothorax after surgery for lung and mediastinum malignant tumors

Pikin OV, Trakhtenberg AKh, Glushko VA, Kolbanov KI, Vursol DA, Belko AD

PA Herzen Moscow Cancer Research Institute, Moscow, Russia
Contact: Pikin OV, e-mail:

Chylothorax is relatively infrequent complication in patients who underwent surgery for lung and mediastinum malignant tumors, but increasingly aggressive surgical tactics for this tumors causes higher incidence of this complication in the postoperative period.

Materials and methods. Nine hundred forty five surgeries for lung and mediastinum malignant tumors were performed between 2000 and 2011 in PA Herzen Moscow Cancer Research Institute. Chylothorax was diagnosed in 12 cases, moreover its rate after mediastinum surgery was 3.2% (2 of 61) and 1.1% (10 of 884) after lung surgery. Treatment was started with conservative therapy, which included cessation of oral intake, total parenteral nutrition and subcutaneous octreotide.

Results. Conservative therapy was effective in 6 (50%) cases, notably lobectomy was performed in all cases. In 6 (50%) cases because of inefficiency of concervative therapy rethoracotomy was performed with thoracic duct ligation proximaly and distaly to the injury. Volume of the chylorrhea in such patients was over 1000 ml per day.

In 5 of 6 (83.3%) patients the origin of chylorrhea was identified, in 4 cases it was the main branch of thoracic duct, in 1 case it was its inflow. In one patient the injury localization was not determined thus which the duct was ligated in the supradiaphragmatic part. No mortally was noticed. One patient had pleural empyema developed after pneumonectomy and rethoracotomy for chylothorax, which required extended drainage and sanation of pleural cavity.

Conclusion. Chylotorax treatment should he started with conservative therapy, which in some cases leads to targeted outcome, avoiding surgical reintervention. If no effect of therapy and preservation of high chylorrhea rate during 2 weeks or in case of progressing lymphopenia and starting patient malnutrition the surgical treatment should be performed. If the chylorrhea rate is more than 1000 ml per day during first 3-5 days after the operation while conservative therapy is held, especially in case of previous pneumonectomy, a surgery for thoracic duct ligation should be performed in early period.

KEY WORDS: chylothorax, thoracic surgery, treatment.

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