Review of nine cases of postoperative chylothorax

Abstract

Nine patients experienced postoperative chylothorax during a 5-year period when 931 thoracotomies were performed, for an overall incidence of 1.0%. Seven of the nine had lung cancer : six were treated with lobectomy and one with pneumonectomy. One patient with which malignant mesothelioma and one with metastatic lung cancer underwent pleuropneumonectomy. Mediastinal lymph node dissections were performed in eight patients, but not in the one with metastatic lung cancer.
In six patients chylothorax was caused by node dissection and in remaining three it followed an extrapleural approach. Six patients who had had lobectomy were treated conservatively by fasting, IVH and pleural drainage for an average of 36.3 days. There were no complications of malnutrition or infection. The three patients who had had pneumonectomy required re-operation. Milk taken before operation effectively shows the site of injury in the thoracic duct.
Chylothorax after lobectomy can be treated nonoperatively, but operation should be performed as soon as possible in patients who have had pneumonectomy.