Post-esophagectomy chylothorax successfully treated with the combination of thoracic duct clipping and octreotide administration
Tóm tắt
We herein describe the case of a 61-year-old man with stage II esophageal cancer who experienced chylothorax after esophagectomy. He was successfully treated with thoracic duct clipping and octreotide administration. Previously the patient had had a head and neck cancer treated with multimodality treatment: neoadjuvant chemoradiation therapy, operation, and adjuvant CRT. Then, esophagectomy with lymph node dissection without resection of the thoracic duct was performed via a right thoraco-abdominal approach. On postoperative day 1, enteral nutrition was started. On day 5, the chest tube drainage increased to 2000 ml per day. On day 7, the drainage fluid increased to 3000 ml per day, and its color turned cloudy white. We then performed lymphoscintigraphy and diagnosed the patient as having chylothorax. Immediately we administered intermittent subcutaneous octreotide 100 μg × 3 per day; however, it could not stop the leakage. On day 13, we performed an operation: a fat-rich supplement was administered through the jejunostomy tube before the operation, the thoracic duct injury was readily identified, and we clipped the thoracic duct in the superior mediastinum, followed by 300 μg per day octreotide treatment. On day 16, however, 400 ml per day of chyle leaked from the drain again, and we increased the dose of octreotide to 600 μg per day. On day 18, the drainage stopped, and the patient was discharged on day 38. Octreotide administration combined with surgical treatment should be considered as a treatment option for chylothorax, which is a rare complication of esophagectomy.
Tài liệu tham khảo
Fahimi H, Casselman FP, Mariani MA, van Boven WJ, Knaepen PJ, van Swieten HA. Current management of postoperative chylothorax. Ann Thorac Surg. 2001;71:448–50.
Hayden JD, Sue-Ling HM, Sarela AI, Dexter SP. Minimally invasive management of chylous fistula after esophagectomy. Dis Esophagus. 2007;20:251–5.
Tachibana M, Kinugasa S, Yoshimura H, Dhar DK, Ueda S, Fujii T, et al. Does fibrin glue reduce lymph leakage (pleural effusion) after extended esophagectomy? Prospective randomized clinical trial. World J Surg. 2003;27:776–81.
Mine S, Udagawa H, Kinoshita Y, Makuuchi R. Post-esophagectomy chylous leakage from a duplicated left-sided thoracic duct ligated successfully with left-sided video-assisted thoracoscopic surgery. Interact Cardiovasc Thorac Surg. 2008;7:1186–8.
Buettiker V, Hug MI, Burger R, Baenziger O. Somatostatin: a new therapeutic option for the treatment of chylothorax. Intensive Care Med. 2001;27:1083–6.
Gómez-Caro AA, Moradiellos Diez FJ, Marrón CF, Larrú Cabrero EJ, Martín de Nicolás JL. Conservative management of postsurgical chylothorax with octreotide. Asian Cardiovasc Thorac Ann. 2005;13:222–4.
Buck ML. Octreotide for the management of chylothorax in infants and children. Pediatr Pharm. 2004;10(10).
Markham KM, Glover JL, Welsh RJ, Lucas RJ, Bendick PJ. Octreotide in the treatment of thoracic duct injuries. Am Surg. 2000;66:1165–7.
Michelet P, Embriaco N, Roch A, Giudicelli R, Auffray JP. Somatostatin for the treatment of a post-oesophagectomy chylothorax. Ann Fr Anesth Reanim. 2004;23:56–8.
Collard JM, Laterre PF, Boemer F, Reynaert M, Ponlot R. Conservative treatment of postsurgical lymphatic leaks with somatostatin-14. Chest. 2000;117:902–5.
Bybel B, Neumann DR, Kim BY, Amin K, Rice T. Lymphoscintigraphy using (99m)Tc filtered sulfur colloid in chylothorax: a case report. J Nucl Med Technol. 2001;29:30–1.
Robinson CL. The management of chylothorax. Ann Thorac Surg. 1985;39:90–5.
Jiang H, Deng XF, Duan CM, Chen C, Xiang JL, Lu YL, Ma QF. Somatostatin receptors SSTR2 and SSTR5 are expressed in the human thoracic duct. Lymphology. 2011;44:21–8.