Lipiodol Lymphangiography and Selective Pleurodesis were Effective against Refractory Chylothorax after Salvage Esophagectomy

Abstract

Chylothorax can be a postoperative complication after esophagectomy. Once it occurs, it leads to longer hospital stay and costs. We report a case of selective pleurodesis for refractory postoperative chylothorax. A 69-year-old man was found to have complete response after chemoradiotherapy for thoracic esophageal carcinoma (T3N2M0). Seven months later, salvage esophagectomy with 2-field lymph node dissection through a right thoracotomy was performed for local recurrence. Chylothorax appeared when we started enteral nutrition at 4 hours after surgery. It was unresponsive to conventional therapies, such as fasting, total parental nutrition, and octreotide acetate. Then we detected two leakage points at the right upper mediastinum through lipiodol lymphangiography on POD10. Although conventional pleurodesis was performed, the chylothorax continued. Selective pleurodesis, involving injection of OK-432 10KE and minocycline through the catheter against the leakage sites of right upper mediastinum, underwent on POD 17. The chylothorax immediately decreased without any side effects, and the chest tube was removed on POD 23.