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Thoracic Duct Embolization for Delayed Chyle Leak After Lewis-Tanner Esophagectomy. | LitMetric

AI Article Synopsis

  • Radical esophagectomy is a surgery for esophageal cancer that can lead to serious complications, including chyle leak (CL), which occurs in about 1-9% of cases and can increase morbidity and mortality.
  • A case study of a 54-year-old man who developed a delayed CL after surgery revealed that he experienced severe complications and required advanced imaging and treatment to address the issue.
  • The study concludes that thoracic duct embolization is a simple and effective first-line treatment for high-output CL occurring more than two weeks post-surgery.

Article Abstract

BACKGROUND Radical esophagectomy for cancer is a potentially curative treatment that requires two/three-field lymphadenectomy. Serious complications can occur, including chyle leak (CL). CL has an incidence rate of 1-9% and is associated with a higher rate of postsurgical morbidity and mortality. It usually occurs in the early postoperative period; delayed CL is less common and is thought to be due to an occult leak or late diagnosis. CASE REPORT A 54-year-old man with adenocarcinoma of the esophagus underwent Lewis-Tanner esophagectomy after neoadjuvant chemotherapy with FLOT. During en bloc lymphadenectomy, the main thoracic duct was identified, clipped, and divided. The postoperative course was uneventful. One month after hospital discharge, he was readmitted with severe abdominal, scrotal, and lower-limb edema. A chest-abdomen CT scan revealed massive pleural effusion with left shift and compression of the mediastinum. The patient was initially treated with fasting and fat-free total parenteral nutrition, and the drain output was 2800-3000 mL/dL. Lymphoscintigraphy with ethiodized oil eventually revealed a thoracic duct leak, and lymphatic embolization was successfully performed with a 4-mm metallic spiral and glue. Drain output dramatically reduced, and after 11 days the thoracic drain was removed and the patient was safely discharged. CONCLUSIONS Thoracic duct embolization seems be an effective therapy in treating high-output (>1000 mL/dL) CL that has occurred more than 2 weeks after esophagectomy. It can be considered as a first-line treatment due to its simplicity and effectiveness.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9319296PMC
http://dx.doi.org/10.12659/AJCR.936590DOI Listing

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