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J Thorac Cardiovasc Surg 2002;124:499-502
© 2002 The American Association for Thoracic Surgery

General Thoracic Surgery (GTS)

Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer

From the Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa Chiba, Japan.

Supported in part by a grant-in-aid for cancer research from the Ministry of Health, Labour and Welfare, Japan.

Received for publication Sept 18, 2001. Revisions requested Dec 12, 2001; revisions received Jan 8, 2002. Accepted for publication Feb 21, 2002. Address for reprints: Kimihiro Shimizu, MD, Division of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa Chiba, 277-8577, Japan (E-mail: kmshimiza{at}showa.gunmau.ac.jp).

Objective: We reviewed our experience with iatrogenic chylothorax after pulmonary resections for lung cancer to evaluate our treatment strategy and to identify factors that predict the need for reoperation.
Methods: From July 1992 through February 2000, a total of 1110 patients underwent pulmonary resection (at least lobectomy) and systematic mediastinal lymph node dissection for lung cancer at our division. Twenty-seven patients (2.4%) had postoperative chylothorax develop. We initially treated 26 of these patients conservatively with complete oral intake cessation and total parenteral nutrition, and these patients constituted the subjects in this study.
Results: There were 21 men and 5 women with a median age of 62 years (range 44 to 80 years). The initial procedures were pneumonectomy in 2 cases, bilobectomy in 1 case, and lobectomy in 23 cases. Twenty-one patients (81%) had the condition cured with conservative treatment. These patients resumed a normal diet at a median of 8 days after chylothorax diagnosis (range 4-35 days). The remaining 5 patients (19%) underwent reoperation at a median of 14 days after diagnosis (range 5-35 days). Chest tube drainage of less than 500 mL during the first 24 hours after complete oral intake cessation and total parenteral nutrition predicted a cure with conservative treatment.
Conclusion: Although most cases of chylothorax after pulmonary resection with systematic mediastinal lymph node dissection can be cured with a conservative strategy, early surgical intervention may be indicated if chest tube drainage is more than 500 mL during the first 24 hours after complete oral intake cessation and total parenteral nutrition.

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