Guillem et al[2929 Guillem P, Papachristos I, Peillon C, Triboulet J P. Etilefrine use in the management of post-operative chyle leaks in thoracic surgery. Interact Cardiovasc Thorac Surg. 2004;3(1):156-60. doi:10.1016/ S1569-9293(03)00263-9. https://doi.org/10.1016/ S1569-9293(03)0...
] |
2004 |
Cohort |
Uninformed |
Esophagectomy, lobectomy, gastrectomy |
8 |
Daily output of at least 250 ml or chyle leaks with a duration of at least 7 days |
52 |
TPN + MCT |
Duct ligation |
Marts et al[3232 Marts BC, Naunheim KS, Fiore AC, Pennington DG. Conser vative versus surgical management of chylothorax. Am J Surg. 1992;164(5):532-4; discussion 534-5. doi:10.1016/s0002-9610(05)81195-x. https://doi.org/10.1016/s0002-9610(05)81...
] |
1992 |
Cohort |
Uninformed |
Congenital heart surgery, esophagectomy, trauma, miscellaneous thoracic procedures |
29 |
Milky-appearing fluid, a pH between 7.4 and 7.8, triglyceride level > 110 mg/dL, fat globules seen on a Sudan III stain, or chylomicrons proven by electrophoresis. In addition, a specific gravity > 1.012 or a high pleural fluid cell count with lymphocyte predominance |
20 |
TPN + low-fat diet; low-fat diet + MCT |
Duct ligation |
Alexiou et al[2020 Alexiou C, Watson M, Beggs D, Salama FD, Morgan WE. Chylothorax following oesophagogastrectomy for malignant disease. Eur J Cardiothorac Surg. 1998;14(5):460-6. doi:10.1016/s1010-7940(98)00230-9. https://doi.org/10.1016/s1010-7940(98)00...
] |
1998 |
Cohort |
523 |
Esophagectomy |
21 |
Confirmed by the change in fluid character to milky after commencement of enteral feeding and the presence of chylomicrons on biochemical analysis of the pleural fluid |
65 |
TPN |
Duct ligation |
Allaham et al[2121 Allaham AH, Estrera AL, Miller CC 3rd, Achouh P, Safi HJ. Chylothorax complicating repairs of the descending and thoracoabdominal aorta. Chest. 2006;130(4):1138-42. doi:10.1378/chest.130.4.1138. https://doi.org/10.1378/chest.130.4.1138...
] |
2006 |
Cohort |
1159 |
Aortic surgical procedures |
5 |
Triglyceride levels 100 mg/dL or predominant presence of lymphocytes confirmed the diagnosis |
64 |
TPN |
Duct ligation |
Bolger et al[2222 Bolger C, Walsh TN, Tanner WA, Keeling P, Hennessy T P. Chylothorax after oesophagectomy. Br J Surg. 1991;78(5):587-8. doi:10.1002/ bjs.1800780521. https://doi.org/10.1002/ bjs.1800780521...
] |
1991 |
Cohort |
537 |
Esophagectomy |
11 |
Drainage of straw-coloured fluid from the chest drain continued for > 5 days and it was confirmed as a chylous leak by its milky white appearance following the administration of cream through the nasogastric tube |
Uninformed |
TPN |
Duct ligation |
Bonavina et al[2323 Bonavina L, Saino G, Bona D, Abraham M, Peracchia A. Thoracoscopic management of chylothorax complicating esophagectomy. J Laparoendosc Adv Surg Tech A. 2001;11(6):367-9. doi:10.1089/10926420152761888. https://doi.org/10.1089/1092642015276188...
] |
2001 |
Cohort |
316 |
Esophagectomy |
3 |
Presence of milky fluid in the chest tube and bilateral pleural effusion after the removal of the chest tube |
56 to 63 |
TPN |
Duct ligation |
Cerfolio et al[2424 Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative chylothorax. J Thorac Cardiovasc Surg. 1996;112(5):1361-5; discussion 1365-6. doi:10.1016/S0022-5223(96)70152-6. https://doi.org/10.1016/S0022-5223(96)70...
] |
1996 |
Cohort |
11315 |
Esophagectomy, aortic surgical procedures, pulmonary resections, mediastinal mass resection |
47 |
Triglyceride content of 110 mg/dl or greater and the presence of chylomicrons in the pleural fluid in all patients |
65 |
TPN;MCT |
Duct ligation |
Dugue et al[2626 Dugue L, Sauvanet A, Farges O, Goharin A, Le Mee J, Belghiti J. Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy. Br J Surg. 1998;85(8):1147-9. doi:10.1046/j.1365-2168.1998.00819.x. https://doi.org/10.1046/j.1365-2168.1998...
] |
1998 |
Cohort |
850 |
Esophagectomy |
23 |
Suspected as early as the third postoperative day when the chest drainage output was > 500 ml per 24 h with a lymphocyte count of > 50%. The diagnosis was confirmed by injection of a cream rich diet through the nasogastric tube which resulted in a milky appearance of the pleural fluid |
54 |
TPN |
Duct ligation |
Lagarde et al[3030 Lagarde SM, Omloo JM, de Jong K, Busch OR, Obertop H, van Lanschot JJ. Incidence and management of chyle leakage after esophagectomy. Ann Thorac Surg. 2005;80(2):449-54. doi:10.1016/j. athoracsur.2005.02.076. https://doi.org/10.1016/j. athoracsur.20...
] |
2005 |
Cohort |
536 |
Esophagectomy |
20 |
Drain output changed from yellow to milky after start of enteral feeding (or administration of cream) and changed back again to yellow after discontinuation of enteral feeding. Triglyceride concentration in the drain output was > 1.2 mmol/L |
62 |
TPN |
Duct ligation |
Merigliano et al[3333 Merigliano S, Molena D, Ruol A, Zaninotto G, Cagol M, Scappin S, et al. Chylothorax complicating esophagectomy for cancer: a plea for early thoracic duct ligation. J Thorac Cardiovasc Surg. 2000;119(3):453-7. doi:10.1016/s0022-5223(00)70123-1. https://doi.org/10.1016/s0022-5223(00)70...
] |
2000 |
Cohort |
1787 |
Esophagectomy |
11 |
Suspected in the presence of excessive (> 1000 mL per day) chest or mediastinal output continuing for >2 days and it was confirmed by physical and biochemical analysis of the fluid |
57 |
TPN |
Duct ligation |
Seow et al[3535 Seow C, Murray L, McKee RF. Surgical pathology is a predictor of outcome in post-operative lymph leakage. Int J Surg. 2010;8(8):636-8. doi:10.1016/j.ijsu.2010.07.297. https://doi.org/10.1016/j.ijsu.2010.07.2...
] |
2010 |
Cohort |
442 |
Esophagectomy |
10 |
Postoperative lymph leak > 500 ml over 48 h |
Uninformed |
TPN |
Duct ligation |
Shah et al[3636 Shah RD, Luketich JD, Schuchert MJ, Christie NA, Pennathur A, Landreneau RJ, et al. Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg. 2012;93(3):897-903; discussion 903-4. doi:10.1016/j.athoracsur.2011.10.060. https://doi.org/10.1016/j.athoracsur.201...
] |
2012 |
Cohort |
892 |
Esophagectomy |
34 |
Change in the quality of chest tube drainage to milky white drainage, regardless of chest tube output, or confirmation of chylomicrons or triglycerides in the pleural drainage in patients with high-volume drainage |
67 |
TPN; enteral nutrition |
Duct ligation |
Shen et al[3737 Shen Y, Feng M, Khan MA, Wang H, Tan L, Wang Q. A simple method minimizes chylothorax after minimally invasive esophagectomy. J Am Coll Surg. 2014;218(1):108-12. doi:10.1016/j.jamcollsurg.2013.09.014. https://doi.org/10.1016/j.jamcollsurg.20...
] |
2014 |
Cohort |
344 |
Esophagectomy |
10 |
Laboratory confirmation of elevated triglycerides (> 110 mL/dL) or positive Sudan III stain in the setting of sustained drainage |
Uninformed |
TPN |
Duct ligation |
Petrella et al[1414 Petrella F, Casiraghi M, Radice D, Bertolaccini L, Spaggiari L. Treatment of chylothorax after lung resection: indications, timing, and outcomes. Thorac Cardiovasc Surg. 2020;68(6):520-4. doi:10.1055/s-0040-1710071. https://doi.org/10.1055/s-0040-1710071...
] |
2020 |
Cohort |
5072 |
Esophagectomy, pulmonary resections, mediastinal mass resection |
30 |
Chylous leakage from the chest drainage with the presence of triglycerides (> 110mg/dL) in the pleural fluid |
63 |
TPN;TPN + low-fat diet |
Duct ligation |
Furukawa et al[2828 Furukawa M, Hara A, Miyazaki R, Yokoyama S, Hayashi M, Tao H, et al. [Assessment of Fat-free Diet for Postoperative Chylothorax]. Kyobu Geka. 2018;71(13):1063-5. Japanese.] |
2018 |
Cohort |
818 |
Pulmonary resection |
14 |
Uninformed |
Uninformed |
TPN; low-fat diet |
Uninformed |
Takuwa et al[3939 Takuwa T, Yoshida J, Ono S, Hishida T, Nishimura M, Aokage K, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg. 2013;146(3):571-4. doi:10.1016/j. jtcvs.2013.04.015. https://doi.org/10.1016/j. jtcvs.2013.04...
] |
2013 |
Cohort |
1580 |
Pulmonary resection |
37 |
Chylous leakage from a chest tube with an elevated triglyceride level (> 110mg/dL) in the drainage fluid |
69 |
TPN + low-fat diet |
Duct ligation |
Pego-Fernandes et al[3434 Pego-Fernandes PM, Nascimbem MB, Ranzani OT, Shimoda MS, Monteiro R, Jatene FB. Video-assisted thoracoscopy as an option in the surgical treatment of chylothorax after cardiac surgery in children. J Bras Pneumol. 2011;37(1):28-35. doi:10.1590/s1806-37132011000100006. https://doi.org/10.1590/s1806-3713201100...
] |
2011 |
Cohort |
3092 |
Cardiac surgery |
64 |
High level of triglycerides (> 110 mg/dL) or a level of triglyceride/cholesterol > 1 in the pleural fluid; presence of leukocytes and chylomicrons in the fluid |
2 |
TPN;TPN + low-fat diet; MCT |
Duct ligation |
Chan et al[2525 Chan EH, Russell JL, Williams WG, Van Arsdell GS, Coles JG, McCrindle BW. Postoperative chylothorax after cardiothoracic surgery in children. Ann Thorac Surg. 2005;80(5):1864-70. doi:10.1016/j. athoracsur.2005.04.048. https://doi.org/10.1016/j. athoracsur.20...
] |
2005 |
Cohort |
1257 |
Cardiac surgery |
48 |
Triglyceride levels in pleural fluid had to be 1.2 mmol/L, with a total cell number 1,000 cell s/mL and a predominance of mononuclear cells |
1 |
TPN; low-fat diet |
Duct ligation |
Fahimi et al[2727 Fahimi H, Casselman FP, Mariani MA, van Boven WJ, Knaepen PJ, van Swieten HA. Current management of postoperative chylothorax. Ann Thorac Surg. 2001;71(2):448-50; discussion 450-1. doi:10.1016/ s0003-4975(00)02033-6. https://doi.org/10.1016/ s0003-4975(00)0...
] |
2001 |
Cohort |
Uninformed |
Aortic surgery, pulmonary resection, cardiac surgery, mediastinoscopy, sypathectomy |
12 |
Postoperative pleural or epicardial effusion unexpectedly large and presence of triglycerides and chylomicrons in the fluid |
61 |
MCT |
Duct ligation; fibrin glue if site of injury could not be identified |
Le Pimpec-Barthes et al[3131 Le Pimpec-Barthes F, D'Attellis N, Dujon A, Legman P, Riquet M. Chylothorax complicating pulmonary resection. Ann Thorac Surg. 2002;73(6):1714-9. doi:10.1016/s0003-4975(02)03570-1. https://doi.org/10.1016/s0003-4975(02)03...
] |
2002 |
Cohort |
Uninformed |
Pulmonary resection |
26 |
Appearance of a milky pleural effusion with an elevated triglyceride level > 100 mg/dL (triglycerides 1 mg/100 mL = 0.0113 mmol/L), a lymphocyte count > 90% of total white blood cell count, and total protein concentration approaching that of plasma |
57 |
TPN;TPN + MCT |
Duct ligation; suture of leaking collateral; fibrin glue |
Shimizu et al[3838 Shimizu K, Yoshida J, Nishimura M, Takamochi K, Nakahara R, Nagai K. Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg. 2002;124(3):499-502. doi:10.1067/mtc.2002.124386. https://doi.org/10.1067/mtc.2002.124386...
] |
2002 |
Cohort |
1110 |
Pulmonary resection |
26 |
Presence of triglycerides (> 110 mg/dL)and chylomicrons in the drainage fluid |
62 |
TPN |
Uninformed |
Worthington et al[4040 Worthington MG, de Groot M, Gunning AJ, von Oppell UO. Isolated thoracic duct injury after penetrating chest trauma. Ann Thorac Surg. 1995;60(2):272-4. doi:10.1016/0003-4975(95)00415-h. https://doi.org/10.1016/0003-4975(95)004...
] |
1995 |
Cohort |
Uninformed |
Penetrating chest trauma |
8 |
Uninformed |
23 |
TPN; MCT |
Duct ligation |