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Embolization or disruption of thoracic duct and cisterna chyli leaks post oesophageal cancer surgery should be first line management for ECCG-defined type III chyle fistulae

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Abstract

Chyle leakage from the thoracic duct or cisterna chyli is a relatively rare complication of oesophageal cancer surgery. The majority of cases settle with conservative measures, but high volume leaks may be refractory and result in significant morbidity and require intervention with reoperation or embolization. In the experience of this high-volume centre over the last decade, 3 (0.5%) patients required reoperation and ligation of the thoracic duct; for the so-called type III leaks, interventional radiological approaches were not considered. This article is built around two recent cases, where interventional radiology to embolize and disrupt complex fistulae was successfully performed. The lessons from this experience will change practice at this centre to initial lymphangiography with a view to embolization or disruption of thoracic duct and cisterna chyli leaks as first line therapy for type III chyle leaks, with surgery reserved for where this fails.

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Authors and Affiliations

  1. Department of Surgery, National Oesophageal and Gastric Cancer Center, St. James’s Hospital and Trinity College Dublin, Dublin, Ireland

    Noel E. Donlon, Tim S. Nugent, Robert Power, Waqas Butt, Ahmad Kamaludin, Narayanasamy Ravi & John V. Reynolds

  2. Department of Interventional Radiology, St. James’s Hospital and Beacon Hospital, Dublin, Ireland

    Steven Dolan, Michael Guiney & Niall Mc Eniff

Authors
  1. Noel E. Donlon
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  2. Tim S. Nugent
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  3. Robert Power
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  4. Waqas Butt
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  5. Ahmad Kamaludin
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  6. Steven Dolan
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  7. Michael Guiney
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  8. Niall Mc Eniff
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  9. Narayanasamy Ravi
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  10. John V. Reynolds
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Contributions

Noel E Donlon contributed to the authorship.

Timothy S Nugent contributed to the concept of study.

Robert Power contributed to the data collection.

Waqas Butt contributed to the image collection.

Ahmed Kamaludin contributed to the data collection.

Steven Dolan contributed to the authorship.

Michael Guiney contributed to the revision of the manuscript.

Niall Mc Eniff contributed to the figure revision of manuscript.

Narayanasamy Ravi contributed to the authorship of manuscript.

John V Reynolds contributed to the design of paper and revisions.

Corresponding author

Correspondence to Noel E. Donlon.

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All authors declare no conflict of interest.

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Ethical approval to carry out this study was granted by our local ethics committee.

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Donlon, N.E., Nugent, T.S., Power, R. et al. Embolization or disruption of thoracic duct and cisterna chyli leaks post oesophageal cancer surgery should be first line management for ECCG-defined type III chyle fistulae. Ir J Med Sci 190, 1111–1116 (2021). https://doi.org/10.1007/s11845-020-02396-z

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  • DOI: https://doi.org/10.1007/s11845-020-02396-z

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