Chylothorax Complicating Pulmonary Resection for Lung Cancer: Effective Management and Pleurodesis

Abstract

Background. Chylothorax associated with pulmonary resection for lung cancer, although rare, must be considered as a potential complication during thoracic surgery. In the present study, we investigated the effectiveness of a conservative approach (diet or pleurodesis) to the management of chylothorax. Methods. Between January 2000 and December 2010, 3,120 consecutive patients underwent pulmonary resection and mediastinal lymph node dissection at our institution. Among them, 67 patients with confirmed chylothorax were retrospectively reviewed. Results. Right-sided chylothorax was more common than left-sided chylothorax (p = 0.033). All patients were initially treated with nil per os (NPO; n = 46) or a low long-chain triglyceride (LCT) diet (n = 21). In the NPO group, 24 patients were successfully treated with diet alone and 20 underwent pleurodesis. In the LCT group, 10 patients were successfully treated with diet alone; of the 11 remaining patients, 4 patients improved after NPO. The 7 patients who did not improve with NPO underwent pleurodesis. No significant differences in chest tube output before and after initial treatment, length of stay, or success rate were observed between patients initially treated with NPO and those receiving low LCT. All 32 pleurodeses performed in 27 patients were successful. Two patients underwent surgery without pleurodesis after dietary treatment failure. Postoperative air leakage or drainage for 5 days greater than 21.6 mL/kg were independent risk factors for dietary treatment failure. Conclusions. Conservative treatment, including pleurodesis, should be the first choice of treatment for chylothorax complicating pulmonary resection. (C) 2014 by The Society of Thoracic Surgeons