Clinical treatment strategy and effect of chylothorax after video-assisted thoracoscopic lung cancer surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DONG Yingxian , LAI Yutian , ZHOU Kun ,  CHE Guowei

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

CHE Guowei, Email: cheguowei_hx@aliyun.com

Keywords：

Chylothorax; lung cancer; treatment method; surgery

DOI：

10.7507/1007-4848.202012093

Video：

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Objective To review and analyze the treatment of chylothorax after video-assisted thoracoscopic lung cancer surgery and to discuss the best clinical treatment methods and effects.Methods A total of 400 patients diagnosed with chylothorax at the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2012 to January 2020 were continuously collected. According to the inclusion and exclusion criteria, 37 patients were finally included. There were 20 males and 17 females with an average age of 55.55±10.49 years. Chylothorax was diagnosed primarily by triglyceride levels (above 110 mg/dL) or the Sudan triple stain test. Treatment included surgical and non-surgical treatment. The overall incidence, high risk factors and treatment methods of chylothorax after radical thoracoscopic surgery for lung cancer were analyzed. According to the treatment methods, the patients were divided into a surgical treatment group and a non-surgical treatment group. The average daily drainage volume and average hospital stay of the patients between the two groups were analyzed.Results Included patients accounted for 0.3% (37/12 515) of lung cancer thoracoscopic surgery in our hospital during the same period. The incidence of postoperative chylothorax in patients with right lung surgery (0.2%, 29/12 515) was higher than that of patients with left lung surgery (0.1%, 8/12 515). Of 37 patients with chylothorax after lung cancer surgery, 32 patients were in the non-surgical treatment group (86.5%, 32/37), and the rate was higher compared with the surgical treatment group (13.5%, 5/37, P=0.000). The average daily drainage in the surgical treatment group was 777 mL more than that in the non-surgical treatment group (95%CI 588.58 to 965.55, P<0.001). The total drainage volume of the surgical treatment group was more than that of the non-surgical treatment group (8 609.2±4 680.3 mL vs. 4 911.2±3 925.5 mL, P=0.055). The postoperative hospital stay and total hospital stay in the surgical treatment group were shorter than those in the non-surgical treatment group (P=0.162, P=0.118). The tube indwelling time (8.2±2.7 d) was shorter than that of the non-surgical treatment group (12.3±6.8 d, P=0.204).Conclusion The treatment of chylothorax after radical resection of VATS lung cancer is still mainly non-surgical treatment. Surgical treatment should be initiated as early as possible when the drainage volume is too large 72 hours after chylothorax surgery after radical resection of VATS lung cancer.

Citation： DONG Yingxian, LAI Yutian, ZHOU Kun, CHE Guowei. Clinical treatment strategy and effect of chylothorax after video-assisted thoracoscopic lung cancer surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 62-67. doi: 10.7507/1007-4848.202012093 Copy

1.	Liu CY, Hsu PK, Huang CS, et al. Chylothorax complicating video-assisted thoracoscopic surgery for non-small cell lung cancer. World J Surg, 2014, 38(11): 2875-2881.
2.	Wang H, Gao J, Zhang R, et al. Chyle test is not a valuable laboratory index in identifying chylothorax after pulmonary resection and lymph node dissection for primary non-small cell lung cancer. J Cancer Res Ther, 2019, 15(2): 324-328.
3.	Li S, Wang Y, Zhou K, et al. Body surface area as a novel risk factor for chylothorax complicating video-assisted thoracoscopic surgery lobectomy for non-small cell lung cancer. Thorac Cancer, 2018, 9(12): 1741-1753.
4.	Kutlu CA, Sayar A, Olgac G, et al. Chylothorax: A complication following lung resection in patients with NSCLC. Thorac Cardiovasc Surg, 2003, 51(6): 342-345.
5.	Cho HJ, Kim DK, Lee GD, et al. Chylothorax complicating pulmonary resection for lung cancer: Effective management and pleurodesis. Ann Thorac Surg, 2014, 97(2): 408-413.
6.	Wan L, Wang J, Zhao F, et al. Diagnosis and management of chylothorax after resection of lung cancer. Zhongguo Fei Ai Za Zhi, 2009, 12(8): 905-906.
7.	Sarkaria IS, Finley DJ, Bains MS, et al. Chylothorax and recurrent laryngeal nerve injury associated with robotic video-assisted mediastinal lymph node dissection. Innovations (Phila), 2015, 10(3): 170-173.
8.	Uchida S, Suzuki K, Hattori A, et al. Surgical intervention strategy for postoperative chylothorax after lung resection. Surg Today, 2016, 46(2): 197-202.
9.	Wemyss-Holden SA, Launois B, Maddern GJ. Management of thoracic duct injuries after oesophagectomy. Br J Surg, 2001, 88(11): 1442-1448.
10.	Shimizu K, Yoshida J, Nishimura M, et al. Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg, 2002, 124(3): 499-502.
11.	Cerfolio RJ, Allen MS, Deschamps C, et al. Postoperative chylothorax. J Thorac Cardiovasc Surg, 1996, 112(5): 1361-1365.
12.	赵峻, 张德超, 汪良骏, 等. 肺癌与食管癌术后乳糜胸的比较. 中华外科杂志, 2003, 41(1): 4749.
13.	王辰生, 吕会来, 岳国强, 等. 胸外科术后乳糜胸的诊治分析. 河北医药, 2013, 35(18): 2795-2796.
14.	邱宏, 金国琴, 金如锋, 等. 水迷宫重复测量数据的方差分析及其在SPSS中的实现. 中西医结合学报, 2007, 5(1): 101-105.
15.	O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy. Interact Cardiovasc Thorac Surg, 2019, 28(4): 526-534.
16.	Rudrappa M, Paul M. Chylothorax. Treasure island. Florida: StatPearls Publishing, 2018.
17.	Akin H, Olcmen A, Isgorucu O, et al. Approach to patients with chylothorax complicating pulmonary resection. Thorac Cardiovasc Surg, 2012, 60(2): 135-139.
18.	Bryant AS, Minnich DJ, Wei B, et al. The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg, 2014, 98(1): 232-235.
19.	Kawasaki R, Sugimoto K, Fujii M, et al. Therapeutic effectiveness of diagnostic lymphangiography for refractory postoperative chylothorax and chylous ascites: Correlation with radiologic findings and preceding medical treatment. AJR Am J Roentgenol, 2013, 201(3): 659-666.
20.	Nadolski G. Nontraumatic chylothorax: Diagnostic algorithm and treatment options. Tech Vasc Interv Radiol, 2016, 19(4): 286-290.
21.	Zhou WHF, Ma J. Prevention of chylothorax after resection of esophageal cancer by labeling thoracic duct with milk and fat emulsion. Chin J Surg, 1999, 37: 164.
22.	Takuwa T, Yoshida J, Ono S, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg, 2013, 146(3): 571-574.
23.	Chalret du Rieu M, Baulieux J, Rode A, et al. Management of postoperative chylothorax. J Visc Surg, 2011, 148(5): e346-e352.
24.	Zabeck H, Muley T, Dienemann H, et al. Management of chylothorax in adults: When is surgery indicated? Thorac Cardiovasc Surg, 2011, 59(4): 243-246.
25.	Chen C, Wang Z, Hao J, et al. Chylothorax after lung cancer surgery: A key factor influencing prognosis and quality of life. Ann Thorac Cardiovasc Surg, 2020, 26(6): 303-310.
26.	Misthos P, Kanakis MA, Lioulias AG. Chylothorax complicating thoracic surgery: Conservative or early surgical management? Updates Surg, 2012, 64(1): 5-11.
27.	Paul S, Altorki NK, Port JL, et al. Surgical management of chylothorax. Thorac Cardiovasc Surg, 2009, 57(4): 226-228.

1. Liu CY, Hsu PK, Huang CS, et al. Chylothorax complicating video-assisted thoracoscopic surgery for non-small cell lung cancer. World J Surg, 2014, 38(11): 2875-2881.
2. Wang H, Gao J, Zhang R, et al. Chyle test is not a valuable laboratory index in identifying chylothorax after pulmonary resection and lymph node dissection for primary non-small cell lung cancer. J Cancer Res Ther, 2019, 15(2): 324-328.
3. Li S, Wang Y, Zhou K, et al. Body surface area as a novel risk factor for chylothorax complicating video-assisted thoracoscopic surgery lobectomy for non-small cell lung cancer. Thorac Cancer, 2018, 9(12): 1741-1753.
4. Kutlu CA, Sayar A, Olgac G, et al. Chylothorax: A complication following lung resection in patients with NSCLC. Thorac Cardiovasc Surg, 2003, 51(6): 342-345.
5. Cho HJ, Kim DK, Lee GD, et al. Chylothorax complicating pulmonary resection for lung cancer: Effective management and pleurodesis. Ann Thorac Surg, 2014, 97(2): 408-413.
6. Wan L, Wang J, Zhao F, et al. Diagnosis and management of chylothorax after resection of lung cancer. Zhongguo Fei Ai Za Zhi, 2009, 12(8): 905-906.
7. Sarkaria IS, Finley DJ, Bains MS, et al. Chylothorax and recurrent laryngeal nerve injury associated with robotic video-assisted mediastinal lymph node dissection. Innovations (Phila), 2015, 10(3): 170-173.
8. Uchida S, Suzuki K, Hattori A, et al. Surgical intervention strategy for postoperative chylothorax after lung resection. Surg Today, 2016, 46(2): 197-202.
9. Wemyss-Holden SA, Launois B, Maddern GJ. Management of thoracic duct injuries after oesophagectomy. Br J Surg, 2001, 88(11): 1442-1448.
10. Shimizu K, Yoshida J, Nishimura M, et al. Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg, 2002, 124(3): 499-502.
11. Cerfolio RJ, Allen MS, Deschamps C, et al. Postoperative chylothorax. J Thorac Cardiovasc Surg, 1996, 112(5): 1361-1365.
12. 赵峻, 张德超, 汪良骏, 等. 肺癌与食管癌术后乳糜胸的比较. 中华外科杂志, 2003, 41(1): 4749.
13. 王辰生, 吕会来, 岳国强, 等. 胸外科术后乳糜胸的诊治分析. 河北医药, 2013, 35(18): 2795-2796.
14. 邱宏, 金国琴, 金如锋, 等. 水迷宫重复测量数据的方差分析及其在SPSS中的实现. 中西医结合学报, 2007, 5(1): 101-105.
15. O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy. Interact Cardiovasc Thorac Surg, 2019, 28(4): 526-534.
16. Rudrappa M, Paul M. Chylothorax. Treasure island. Florida: StatPearls Publishing, 2018.
17. Akin H, Olcmen A, Isgorucu O, et al. Approach to patients with chylothorax complicating pulmonary resection. Thorac Cardiovasc Surg, 2012, 60(2): 135-139.
18. Bryant AS, Minnich DJ, Wei B, et al. The incidence and management of postoperative chylothorax after pulmonary resection and thoracic mediastinal lymph node dissection. Ann Thorac Surg, 2014, 98(1): 232-235.
19. Kawasaki R, Sugimoto K, Fujii M, et al. Therapeutic effectiveness of diagnostic lymphangiography for refractory postoperative chylothorax and chylous ascites: Correlation with radiologic findings and preceding medical treatment. AJR Am J Roentgenol, 2013, 201(3): 659-666.
20. Nadolski G. Nontraumatic chylothorax: Diagnostic algorithm and treatment options. Tech Vasc Interv Radiol, 2016, 19(4): 286-290.
21. Zhou WHF, Ma J. Prevention of chylothorax after resection of esophageal cancer by labeling thoracic duct with milk and fat emulsion. Chin J Surg, 1999, 37: 164.
22. Takuwa T, Yoshida J, Ono S, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg, 2013, 146(3): 571-574.
23. Chalret du Rieu M, Baulieux J, Rode A, et al. Management of postoperative chylothorax. J Visc Surg, 2011, 148(5): e346-e352.
24. Zabeck H, Muley T, Dienemann H, et al. Management of chylothorax in adults: When is surgery indicated? Thorac Cardiovasc Surg, 2011, 59(4): 243-246.
25. Chen C, Wang Z, Hao J, et al. Chylothorax after lung cancer surgery: A key factor influencing prognosis and quality of life. Ann Thorac Cardiovasc Surg, 2020, 26(6): 303-310.
26. Misthos P, Kanakis MA, Lioulias AG. Chylothorax complicating thoracic surgery: Conservative or early surgical management? Updates Surg, 2012, 64(1): 5-11.
27. Paul S, Altorki NK, Port JL, et al. Surgical management of chylothorax. Thorac Cardiovasc Surg, 2009, 57(4): 226-228.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical treatment strategy and effect of chylothorax after video-assisted thoracoscopic lung cancer surgery

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