Strategies for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer

Abstract Background: Pulmonary resection with mediastinal lymph node dissection for treating primary lung cancer could sometimes causes chylothorax as a postoperative complication. This study examined the validity of treatments for chylothorax in our hospital.Methods: We evaluated 2,019 patients who underwent lobectomy, bilobectomy, or pneumonectomy with mediastinal lymph node dissection for primary lung cancer at Shizuoka Cancer Center Hospital, Shizuoka, Japan, between September 2002 and March 2018. The diagnostic criteria for postoperative chylothorax were that the drainage from the pleural drain was evidently white and turbid, or the pleural effusion contained a triglyceride level of >110 mg/dL. The clinical courses and treatments were retrospectively reviewed.Results: Postoperative chylothorax occurred in 37 patients (1.8%), 20 men and 17 women, with a median age of 70 y (33 to 80). Thirty-five patients had a lobectomy and two patients had a bilobectomy. A low-fat diet was instituted to all patients; 35 cases improved with conservative treatment, and 2 cases required reoperation. Nine cases had a drainage volume ≥ 500 ml one day following the low-fat diet commencement, which was resolved with conservative treatment and decreased drainage was observed on the third day of treatment in seven of those cases.Conclusions: With the exception of cases with excessive drainage of ≥ 1000 mL in one day and systemic symptoms associated with chyle loss, conservative treatment could be successful even when the daily drainage volume exceeds 500 mL following a low-fat diet, provided the drainage volume decreases within three days.