Intranodal lymphangiography for chyle leakage after esophagectomy: A case report

Suetsugu,Tomonari; Tanaka,Yoshihiro; Banno,Shinya; Fukada,Masahiro; Yasufuku,Itaru; Iwata,Yoshinori; Imai,Takeharu; Tanahashi,Toshiyuki; Matsui,Satoshi; Imai,Hisashi; Matsuhashi,Nobuhisa; Takahashi,Takao; Yamaguchi,Kazuya; Tanahashi,Yukichi; Kawada,Hiroshi; Matsuo,Masayuki; Yoshida,Kazuhiro

doi:10.3892/mco.2020.1990

April-2020 Volume 12 Issue 4

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April-2020 Volume 12 Issue 4

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Case Report Open Access

Intranodal lymphangiography for chyle leakage after esophagectomy: A case report

Authors:
- Tomonari Suetsugu
- Yoshihiro Tanaka
- Shinya Banno
- Masahiro Fukada
- Itaru Yasufuku
- Yoshinori Iwata
- Takeharu Imai
- Toshiyuki Tanahashi
- Satoshi Matsui
- Hisashi Imai
- Nobuhisa Matsuhashi
- Takao Takahashi
- Kazuya Yamaguchi
- Yukichi Tanahashi
- Hiroshi Kawada
- Masayuki Matsuo
- Kazuhiro Yoshida
View Affiliations / Copyright

Affiliations: Department of Surgical Oncology, Gifu University School of Medicine, Gifu 501‑1194, Japan, Department of Radiology, Gifu University School of Medicine, Gifu 501‑1194, Japan

Copyright: © Suetsugu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Pages: 343-349
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Published online on: January 30, 2020

https://doi.org/10.3892/mco.2020.1990
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Abstract

Postoperative chylothorax after esophagectomy is a relatively rare complication, but treatment can sometimes be complicated. We report 3 cases of Lipiodol lymphangiography via inguinal lymph node puncture that was effective for chyle leakage occurring after esophagectomy. Case 1: A 67‑year‑old man with stage IIIA esophageal squamous cell carcinoma underwent radical esophagectomy by video‑assisted thoracic surgery (VATS) following neoadjuvant chemotherapy (NAC). After enteral feeding, right pleural effusion drainage increased sharply and changed to white color that was diagnosed as chylothorax. Conservative treatment was started on postoperative day (POD) 15. On POD 50, intranodal Lipiodol lymphangiography and thoracic duct ligation were performed, resulting in complete improvement by the next day. Case 2: A 69‑year‑old man with stage IIIC esophageal cancer was treated salvage operation following chemoradiation. Postoperative chylothorax was diagnosed on POD 6. Despite conservative treatment, the pleural fluid volume did not decrease. Intranodal Lipiodol lymphangiography performed on POD 13 showed contrast medium draining from the thoracic duct near the tracheal bifurcation. Thoracotomy for thoracic duct ligation was performed on POD 15. Thereafter, drainage from the thoracic drain decreased significantly, and the right thoracic drain was removed 4 days later. Case 3: A 65‑year‑old man with Stage IVA hypopharyngeal cancer and Stage IIIA esophageal cancer underwent total pharyngopharyngeal esophagectomy by VATS following NAC. Postoperative chylothorax was diagnosed on POD 7. Despite conservative treatment, the pleural fluid volume did not decrease. Intranodal Lipiodol lymphangiography performed on POD 19 completely visualized the thoracic duct and showed no outflow of contrast from the main thoracic duct into the mediastinum. Pleural fluid decreased remarkably after lymphangiography. Intranodal Lipiodol lymphangiography for postoperative chylothorax accurately visualizes flow within the thoracic duct and clearly depicts its positional relationship with other organs. Besides lymphangiography is not only helps to determine the site of chyle leakage but can also be effective for curing chylothorax by less invasive and safer method.

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1	Merigliano S, Molena D, Ruol A, Zaninotto G, Cagol M, Scappin S and Ancona E: Chylothorax complicating esophagectomy for cancer: A plea for early thoracic duct ligation. J Thorac Cardiovasc Surg. 119:453–457. 2000.PubMed/NCBI View Article : Google Scholar
2	Merrigan BA, Winter DC and O'Sullivan GC: Chylothorax. Br J Surg. 84:15–20. 1997.PubMed/NCBI View Article : Google Scholar
3	Lagarde SM, Omloo JM, de Jong K, Busch OR, Obertop H and van Lanschot JJ: Incidence and management of chyle leakage after esophagectomy. Ann Thorac Surg. 80:449–454. 2005.PubMed/NCBI View Article : Google Scholar
4	Miao L, Zhang Y, Hu H, Ma L, Shun Y, Xiang J and Chen H: Incidence and management of chylothorax after esophagectomy. Thorac Cancer. 6:354–358. 2015.PubMed/NCBI View Article : Google Scholar
5	Itkin M, Kucharczuk JC, Kwak A, Trerotola SO and Kaiser LR: Nonoperative thoracicductembolization for traumatic thoracicduct leak: Experience in 109 patients. J Thorac Cardiovasc Surg. 139:584–589. 2010.PubMed/NCBI View Article : Google Scholar
6	Nadolski GJ and Itkin M: Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol. 23:613–616. 2012.PubMed/NCBI View Article : Google Scholar
7	Yamamoto M, Miyata H, Yamasaki M, Maeda N, Miyazaki Y, Takahashi T, Kurokawa Y, Nakajima K, Takiguchi S, Mori M and Doki Y: Chylothorax after esophagectomy cured by intranodal lymphangiography: A case report. Anticancer Res. 35:891–895. 2015.PubMed/NCBI
8	Ohkura Y, Ueno M, Shindoh J, Iizuka T, Ka H and Udagawa H: Risk factors for postoperative chylothorax after radical subtotal esophagectomy. Ann Surg Oncol. 25:2739–2746. 2018.PubMed/NCBI View Article : Google Scholar
9	Loukas M, Wartmann CT, Louis RG Jr, Tubbs RS, Salter EG, Gupta AA and Curry B: Cisterna chyli: A detailed anatomic investigation. Clin Anat. 20:683–688. 2007.PubMed/NCBI View Article : Google Scholar
10	The Japan Esophageal Society: Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus. Kanehara Co Ltd., Tokyo, 2017.
11	Hara H, Tahara M, Daiko H, Kato K, Igaki H, Kadowaki S, Tanaka Y, Hamamoto Y, Matsushita H, Nagase M and Hosoya Y: Phase II feasibility study of preoperative chemotherapy with docetaxel, cisplatin, and fluorouracil for esophageal squamous cell carcinoma. Cancer Sci. 104:1455–1460. 2013.PubMed/NCBI View Article : Google Scholar
12	Watanabe M, Baba Y, Yoshida N, Ishimoto T, Nagai Y, Iwatsuki M, Iwagami S and Baba H: Outcomes of preoperative chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by esophagectomy in patients with resectable node-positive esophageal cancer. Ann Surg Oncol. 21:2838–2844. 2014.PubMed/NCBI View Article : Google Scholar
13	Yamashita K, Hosoda K, Moriya H, Katada C, Sugawara M, Mieno H, Komori S, Katada N and Watanabe M: Prognostic advantage of docetaxel/cisplatin/5-fluorouracil neoadjuvant chemotherapy in clinical stage II/III esophageal squamous cell carcinoma due to excellent control of preoperative disease and postoperative lymph node recurrence. Oncology. 92:221–228. 2017.PubMed/NCBI View Article : Google Scholar
14	Tanaka Y, Yoshida K, Yamada A, Tanahashi T, Okumura N, Matsuhashi N, Yamaguchi K and Miyazaki T: Phase II trial of biweekly docetaxel, cisplatin, and 5-fluorouracil chemotherapy for advanced esophageal squamous cell carcinoma. Cancer Chemother Pharmacol. 77:1143–1152. 2016.PubMed/NCBI View Article : Google Scholar
15	Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UB and Offord K: The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc. 55:700–704. 1980.PubMed/NCBI
16	Lai FC, Chen L, Tu YR, Lin M and Li X: Prevention of chylothorax complicating extensive esophageal resection by mass ligation of thoracic duct: A random control study. Ann Thorac Surg. 91:1770–1774. 2011.PubMed/NCBI View Article : Google Scholar
17	Fujita T and Daiko H: Efficacy and predictor of octreotide treatment for postoperative chylothorax after thoracic esophagectomy. World J Surg. 38:2039–2045. 2014.PubMed/NCBI View Article : Google Scholar
18	Cerfolio RJ, Allen MS, Deschamps C, Trastek VF and Pairolero PC: Postoperative chylothorax. J Thorac Cardiovasc Surg. 112:1361–1365. 1996.PubMed/NCBI View Article : Google Scholar
19	Kranzfelder M, Gertler R, Hapfelmeier A, Friess H and Feith M: Chylothorax after esophagectomy for cancer: Impact of the surgical approach and neoadjuvant treatment: Systematic review and institutional analysis. Surg Endosc. 27:3530–3538. 2013.PubMed/NCBI View Article : Google Scholar

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Intranodal lymphangiography for chyle leakage after esophagectomy: A case report

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