Prevention of Chylothorax Complicating Extensive Esophageal Resection by Mass Ligation of Thoracic Duct: A Random Control Study

Background. Chylothorax after esophagectomy remains a devastating postoperative complication. Prophylactic mass ligation of the thoracic duct during the extensive resection of esophageal cancer is used to prevent the chylothorax, but there are few published data about its effect. This randomized controlled study was designed to evaluate the preventive effect of thoracic duct mass ligation on postoperative chylothorax. Methods. Six hundred fifty-three patients undergoing transthoracic esophagectomy for cancer were randomly assigned to two groups: 328 patients received esophagectomy (preservation group) and 325 patients received thoracic duct mass ligation during esophagectomy (prevention group). The patients in whom chylothorax developed were identified and occurrence rates of chylothorax were compared between the two groups. The management and outcome of postoperative chylothorax was also recorded. Results. Patients' demographic details were similar between the two groups. No major or minor intraoperative or postoperative complications related to prophylactic thoracic duct mass ligation were recorded. Chylothorax occurred in 8 patients, giving an incidence of 1.2%. In the preservation group, chylothorax occurred in 7 patients (2.1%), and in the prevention group, 1 case of chylothorax was found (0.3%). The incidence of postoperative chylothorax was significantly lower in the prevention group. Among the 8 cases of postoperative chylothorax, 6 patients made an uneventful recovery, but the other 2 patients died of complications (mortality rate, 25%). Conclusions. The technique of intraoperative thoracic duct mass ligation proved safe and effective. It minimized the risk of postoperative chylothorax in patients who underwent transthoracic esophagectomy for cancer. (Ann Thorac Surg 2011;91:1770-4) (C) 2011 by The Society of Thoracic Surgeons