Background: Chylothorax may be primary (spontaneous) or secondary and more often arising as a postoperative complication of thoracic surgery. It occurs when the thoracic duct or its lymphatic tributaries become blocked or perforated or divided resulting in a chylous pleural effusion. Loss of chyle leads to nutritional deficiencies, dehydration, ionic perturbation and lymphocytes leaks thus increasing the vulnerability for infections and respiratory dysfunction. It is a life-threatening complication increasing the postoperative hospital stay. Management of chylothorax is firstly medical which leads to the cessation of leaks in most of the cases.Surgical treatment by thoracic duct ligation is sometimes necessary after failure of medical treatment. The appropriate time for surgical treatment is a subject of controversy. Methods: Reviewing a series of patients treated between 2000 to 2010 in a single center with the same protocol management, the aim of the study was to identify early clinical variables allowing early surgical treatment in postoperative chylothorax.Results: Thirty-two patients were identified in the study period. There were 21 males (65.6%) and 11 females (34.4%) with a mean age of 55.7 years (range from 9 to 79 years) (Table 1).Twenty-two patients (68.75%) had chylothorax after a surgical intervention, seven patients (21.8%) had chylothorax due to medical causes and three patients(9.3%) after chest trauma. Thirty-eight percent of patients treated conservatively were after lung cancer resection and 35% of patients treated surgically where after esophageal resection. Chylothorax was stopped in 33% of patients after lymphangiography. Cumulative leak per day was 1007 ml/day for operated patients and 397 ml/day for patient treated conservatively. Esophageal resection surgery and the amount of fluid leak were the two factors founded to be associated for the decision of an earlier surgical treatment. Conclusion: Chylothorax arising after esophageal resection with a flow rate of leak of more than 500 ml/day should be proposed to an earlier surgical treatment. Lymphangiography remains a key stone assessment with a double aim diagnostic and therapeutic in chyle leakage.
Cite this paper
A. Ramzi, T. Matthieu, J. Jacques, D. Frédéric and V. Jean-Francois, "Are There Early Clinical Factors to Decide Early Surgical Management for Secondary Chylothorax? A Review of 32 Cases," Open Journal of Thoracic Surgery, Vol. 3 No. 2, 2013, pp. 30-36. doi: 10.4236/ojts.2013.32007.
 K. Shimizu, J. Yoshida, M. Nishimura, K. Takamochi, R. Nakahara and K. Nagai, “Treatment Strategy for Chylothorax after Pulmonary Resection and Lymph Node,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 124, No. 3, 2002, pp. 499-502.
 L. Dugue, A. Sauvanet, O. Farges, A. Goharin, J. Le Mee and J. Belghiti, “Output of Chyle as an Indicator of Treatment for Chylothorax Complicating Oesophagectomy,” British Journal of Surgery, Vol. 85, No. 8, 1998, pp. 1147-1149. doi:10.1046/j.1365-2168.1998.00819.x
 A. McWilliams and E. Gabbay, “Chylothorax Occurring 23 Years Post-Irradiation: Literature Review and Management Strategies,” Respirology, Vol. 5, No. 3, 2000, pp. 301-303. doi:10.1046/j.1440-1843.2000.00263.x
 C. Bolger, T. Walsh, W. Tanner and T. Hennessy, “Chylothorax after Oesophagectomy,” British Journal of Surgery, Vol. 78, No. 5, 1991, pp. 587-588.
 D. Dougenis, W. S. Walker, E. W. Cameron and P. R. Walbaum, “Management of Chylothorax Complicating Extensive Esophageal Resection,” Surgery Gynecology & Obstetrics, Vol. 174, No. 6, 1992, pp. 501-506.
 E. Kuntz, “Eine Ubersicht uber das Schrifttum von 1945 bis 1965 mit 297 Fallen und Bericht uber 3 eigene Beobachtungen,” Beitrage zur Klinik und Erforschung der Tuberkulose und der Lungenkrankheiten, Vol. 133, No. 2, 1966, pp. 98-125. doi:10.1007/BF02112815?
 H. B. Shumacker Jr. and T. C. Moore, “Surgical Management of Traumatic Chylothorax,” Surgery Gynecology & Obstetrics, Vol. 93, No. 1, 1951, pp. 46-50.
 A. L. Mcgregor, “Injuries to the Large Lymph-Ducts,” British Journal of Surgery, Vol. 40, No. 164, 1953, pp. 569-574. doi:10.1002/bjs.18004016408
 T. G. Baffes and W. J. Potts, “Postoperative Chylothorax,” Annals of Surgery, Vol. 139, No. 4, 1954, pp. 501-505. doi:10.1097/00000658-195404000-00016
 M. S. Gotsman, “Chylothorax after Closure of a Patent Ductus Arteriosus,” Thorax, Vol. 21, No. 2, 1966, pp. 129-131. doi:10.1136/thx.21.2.129
 J. D. Hardy, G. R. Walker Jr. and V. C. Deguzman, “Thoracic Duct Fistula in Infant. Blue Dye Localization and Operative Closure,” JAMA, Vol. 182, No. 2, 1962, pp. 187-188. doi:10.1001/jama.1962.03050410083021
 J. C. Jones, “Twenty-Five Years’ Experience with the Surgery of Patent Ductus Arteriosus,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 50, 1965, pp. 149-165.
 J. V. Maloney Jr. and F. C. Spencer, “The Nonoperative Treatment of Traumatic Chylothorax,” Surgery, Vol. 40, No. 1, 1956, pp. 121-128.
 C. B. Higgins and D. G. Mulder, “Chylothorax after Surgery for Congenital Heart Disease,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 61, No. 3, 1971, pp. 411-418.
 C. B. Carrington, D. W. Cugell, E. A. Gaensler, A. Marks, R. A. Redding, J. T. Schaaf and A. Tomasian, “Lymphangioleiomyomatosis. Physiologic-Pathologic-Radio-Logic Correlations,” The American Review of Respiratory Diseases, Vol. 116, No. 6, 1977, pp. 977-995.
 B. Corrin, A. A. Liebow and P. J. Friedman, “Pulmonary Lymphangiomyomatosis, a Review,” American Journal of Pathology, Vol. 79, No. 2, 1975, pp. 348-382.
 T. Urban, R. Lazor, J. Lacronique, M. Murris, S. Labrune, D.Valeyre and J. F. Cordier, “Study and Research Group of Pulmonary Orphan Disease,” Medicine (Baltimore), Vol. 78, No. 5, 1999, pp. 321-337.
 M. Reynaud-Gaubert, J. F. Mornex, H. Mal, M. Treihaud, C. Dromer, S. Quetant, F. Leroy-Ladurie, R. Guillemein, F. Philit, G. Dauriat, D. Grenet and M. Stern, “Lung Transplantation for Lymphangiomyomatosis: The French Experience,” Transplantation, Vol. 86, No. 4, 2008, pp. 515-520. doi:10.1097/TP.0b013e31817c15df
 D. Shitrit, G. Izbicki, D. Starobin, D. Aravot and M. R. Kramer, “Late-Onset Chylothorax after Heart-Lung Transplantation,” The Annals of Thoracic Surgery, Vol. 75, No. 1, 2003, pp. 285-286. doi:10.1016/S0003-4975(02)04172-3
 P. G. Cevese, R. Vecchioni, D. F. D’Amico, C. Cordiano, R. Biasiato, G. Favia and G. A. Farello, “Postoperative Chylothorax. Six Cases in 2500 Operations, with a Survey of the World Literature,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 69, No. 6, 1975, pp. 966-971.
 J. Gruwez, A. Lacquet, G. Cardoen, C. Dive and A. Baert, “Considerations on Chylothorax,” Acta Chirurgica Belgica, Vol. 66, No. 1, 1967, pp. 64-78.
 L. A. Brewer 3rd, “Surgical Management of Lesions of the Thoracic Duct; the Technic and Indications for Retroperitoneal Anastomosis of the Thoracic Duct to the Hemiazygos Vein,” The American Journal of Surgery, Vol. 90, No. 2, 1955, pp. 210-227.
 G. S. Fitz-Hugh and R. Cowgill, “Chylous Fistula,” Archives of Otolaryngology, Vol. 91, No. 6, 1970, pp. 543-547. doi:10.1001/archotol.1970.00770040773010
 E. L. Frazell, C. C. Harrold Jr. and L. Rasmussen, “Bilateral Chylothorax; an Unusual Complication of Radical Neck Dissection with Recovery,” Annals of Surgery, Vol. 134, No. 1, 1951, pp. 135-137.
 J. B. Thambo, M. Jimenez, J. Jougon, V. Latrabe, R. Giraradot, D. Crepin, N. Laborde, X. Roques and A. Choussat, “Diagnostic and Therapeutic Value of Lymphography in Persistent Postoperative Chylothorax,” Archives des Maladies du Coeur et des Vaisseaux, Vol. 97, No. 5, 2004, pp. 546-548.
 T. Matsumoto, T. Yamagami, T. Kato, T. Hirota, R. Yoshimatsu, T. Masunami and T. Nishimura, “The Effec-Tiveness of Lymphography as a Treatment Method for Various Chyle Leakages,” British Journal of Radiology, Vol. 82, No. 976, 2009, pp. 286-290.