Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 4/2018

01-04-2018 | Original Scientific Report

Efficacy and Safety of Pleurodesis Using Platelet-Rich Plasma and Fibrin Glue in Management of Postoperative Chylothorax After Esophagectomy

Authors: Daryoush Hamidi Alamdari, Mehdi Asadi, Ahmad Nejad Rahim, Ghodratollah Maddah, Shahariar Azizi, Soudabeh Shahidsales, Mostafa Mehrabibahar

Published in: World Journal of Surgery | Issue 4/2018

Login to get access

Abstract

Introduction

Chylothorax is by definition a collection of lymphatic fluids in the pleural cavity because of leakage from main thoracic duct or its tributaries. It is an uncommon but serious postoperative complication in esophageal cancer patients. There is no standard therapeutic algorithm for chylothorax because no prospective or randomized trials have yet been performed to evaluate the available treatment options. The aim of this study was to evaluate the efficacy of pleurodesis with a combination of platelet-rich plasma (PRP) and fibrin glue to the treatment of chylothorax after trans-hiatal esophagectomy.

Materials and methods

We randomly allocated 52 consecutive esophageal cancer patients with postoperative chylothorax who did not respond to conservative management to either PRP fibrin glue pleurodesis or surgical thoracic duct ligation. 26 patients in each group were treated with PRP fibrin glue pleurodesis or surgical thoracic duct ligation in order to control chylothorax. Perioperative data, including success rate and complications of both interventions, were analyzed.

Results

Two groups were similar in terms of patients’ demographics and tumor characteristics. All 26 patients in pleurodesis group (100%) and 20 patients in surgery group (76.9%) were successfully treated (p = 0.009). Seven patients (26.92%) in pleurodesis group required a second application of PRP fibrin glue after a week. The mean length of hospital stay was 53.50 ± 16.662 days in surgery group and 36.04 ± 8.224 days in pleurodesis group (p < 0.001). Although mortality rate in surgery group was higher than pleurodesis group, it was not statistically significant (p = 0.1621). There was no significant difference in complications between two groups either. No serious side effect occurred with PRP fibrin glue application.

Conclusion

In conclusion, pleurodesis using PRP and fibrin glue for chylothorax after trans-hiatal esophagectomy was associated with significantly increased success rate, decreased ICU stay, decreased overall hospital stay, and decreased mortality compared with surgical thoracic duct ligation. No patient after PRFG required additional intervention including surgery. Thus, given the improved outcomes with PRFG pleurodesis, this technique may be considered in all patients with postoperative chylothorax after or during conservative management and before proceeding to more invasive interventions.
Literature
1.
Lagarde SM, Omloo JM, de Jong K, Busch OR, Obertop H, van Lanschot JJ (2005) Incidence and management of chyle leakage after esophagectomy. Ann Thorac Surg 80(2):449–454CrossRefPubMed
2.
Shah RD, Luketich JD, Schuchert MJ, Christie NA, Pennathur A, Landreneau RJ et al (2012) Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg 93(3):897–903 discussion-4 CrossRefPubMedPubMedCentral
3.
Ferguson MK, Little AG, Skinner DB (1985) Current concepts in the management of postoperative chylothorax. Ann Thorac Surg 40(6):542–545CrossRefPubMed
4.
Terzi A, Furlan G, Magnanelli G, Terrini A, Ivic N (1994) Chylothorax after pleuro-pulmonary surgery: a rare but unavoidable complication. Thorac Cardiovasc Surg 42(2):81–84CrossRefPubMed
5.
6.
Paes ML, Powell H (1994) Chylothorax: an update. Br J Hosp Med 51(9):482–490PubMed
7.
Macfarlane JR, Holman CW (1972) Chylothorax. Am Rev Respir Dis 105(2):287–291PubMed
8.
Maldonado F, Cartin-Ceba R, Hawkins FJ, Ryu JH (2010) Medical and surgical management of chylothorax and associated outcomes. Am J Med Sci 339(4):314–318CrossRefPubMed
9.
10.
11.
Staats BA, Ellefson RD, Budahn LL, Dines DE, Prakash UB, Offord K (1980) The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc 55(11):700–704PubMed
12.
Huggins JT (2010) Chylothorax and cholesterol pleural effusion. Semin Respir Crit Care Med 31(6):743–750CrossRefPubMed
13.
McGrath EE, Blades Z, Anderson PB (2010) Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 104(1):1–8CrossRefPubMed
14.
Ryu JH, Tomassetti S, Maldonado F (2011) Update on uncommon pleural effusions. Respirology (Carlton, Vic) 16(2):238–243CrossRef
15.
Park JG, Aubry MC, Godfrey JA, Midthun DE (2006) Mediastinal lymphangioma: Mayo Clinic experience of 25 cases. Mayo Clin Proc 81(9):1197–1203CrossRefPubMed
16.
Mine S, Udagawa H, Kinoshita Y, Makuuchi R (2008) Post-esophagectomy chylous leakage from a duplicated left-sided thoracic duct ligated successfully with left-sided video-assisted thoracoscopic surgery. Interact CardioVasc Thorac Surg 7(6):1186–1188CrossRefPubMed
17.
Takuwa T, Yoshida J, Ono S, Hishida T, Nishimura M, Aokage K et al (2013) Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg 146(3):571–574CrossRefPubMed
18.
Akin H, Olcmen A, Isgorucu O, Denizkiran I, Dincer I (2012) Approach to patients with chylothorax complicating pulmonary resection. Thorac Cardiovasc Surg 60(2):135–139CrossRefPubMed
19.
Cho HJ, Kim DK, Lee GD, Sim HJ, Choi SH, Kim HR et al (2014) Chylothorax complicating pulmonary resection for lung cancer: effective management and pleurodesis. Ann Thorac Surg 97(2):408–413CrossRefPubMed
20.
Zabeck H, Muley T, Dienemann H, Hoffmann H (2011) Management of chylothorax in adults: when is surgery indicated? Thorac Cardiovasc Surg 59(4):243–246CrossRefPubMed
21.
22.
23.
Fahimi H, Casselman FP, Mariani MA, van Boven WJ, Knaepen PJ, van Swieten HA (2001) Current management of postoperative chylothorax. Ann Thorac Surg 71(2):448–450 discussion50–51 CrossRefPubMed
24.
Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC (1996) Postoperative chylothorax. J Thorac Cardiovasc Surg 112(5):1361–1365 discussion 5–6 CrossRefPubMed
25.
Shimizu K, Yoshida J, Nishimura M, Takamochi K, Nakahara R, Nagai K (2002) Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg 124(3):499–502CrossRefPubMed
26.
Sriram K, Meguid RA, Meguid MM (2016) Nutritional support in adults with chyle leaks. Nutrition (Burbank, Los Angeles County, Calif) 32(2):281–286CrossRef
27.
Vargas FS, Milanez JR, Filomeno LT, Fernandez A, Jatene A, Light RW (1994) Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions. Chest 106(6):1771–1775CrossRefPubMed
28.
Graham DD, McGahren ED, Tribble CG, Daniel TM, Rodgers BM (1994) Use of video-assisted thoracic surgery in the treatment of chylothorax. Ann Thorac Surg 57(6):1507–1511 discussion 11–12 CrossRefPubMed
29.
Mares DC, Mathur PN (1998) Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series. Chest 114(3):731–735CrossRefPubMed
30.
Paul S, Altorki NK, Port JL, Stiles BM, Lee PC (2009) Surgical management of chylothorax. Thorac Cardiovasc Surg 57(4):226–228CrossRefPubMed
31.
Griffo S, De Luca G, Stassano P (2010) Chylothorax after abdominal surgery. Gen Thorac Cardiovasc Surg 58(3):159–162CrossRefPubMed
32.
33.
Wurnig PN, Hollaus PH, Ohtsuka T, Flege JB, Wolf RK (2000) Thoracoscopic direct clipping of the thoracic duct for chylopericardium and chylothorax. Ann Thorac Surg 70(5):1662–1665CrossRefPubMed
34.
Lyon S, Mott N, Koukounaras J, Shoobridge J, Hudson PV (2013) Role of interventional radiology in the management of chylothorax: a review of the current management of high output chylothorax. Cardiovasc Interv Radiol. 36(3):599–607CrossRef
35.
Liou DZ, Warren H, Maher DP, Soukiasian HJ, Melo N, Salim A et al (2013) Midodrine: a novel therapeutic for refractory chylothorax. Chest 144(3):1055–1057CrossRefPubMed
36.
37.
Al-Zubairy SA, Al-Jazairi AS (2003) Octreotide as a therapeutic option for management of chylothorax. Ann Pharmacother 37(5):679–682CrossRefPubMed
38.
Kelly RF, Shumway SJ (2000) Conservative management of postoperative chylothorax using somatostatin. Ann Thorac Surg 69(6):1944–1945CrossRefPubMed
39.
Markham KM, Glover JL, Welsh RJ, Lucas RJ, Bendick PJ (2000) Octreotide in the treatment of thoracic duct injuries. Am Surg 66(12):1165–1167PubMed
40.
Davis JW, Mackersie RC, Hoyt DB, Garcia J (1994) Randomized study of algorithms for discontinuing tube thoracostomy drainage. J Am Coll Surg 179(5):553–557PubMed
41.
Younes RN, Gross JL, Aguiar S, Haddad FJ, Deheinzelin D (2002) When to remove a chest tube? A randomized study with subsequent prospective consecutive validation. J Am Coll Surg 195(5):658–662CrossRefPubMed
42.
Dietrich W, Ebell A, Busley R, Boulesteix AL (2007) Aprotinin and anaphylaxis: analysis of 12,403 exposures to aprotinin in cardiac surgery. Ann Thorac Surg 84(4):1144–1150CrossRefPubMed
43.
Schenk WG 3rd, Burks SG, Gagne PJ, Kagan SA, Lawson JH, Spotnitz WD (2003) Fibrin sealant improves hemostasis in peripheral vascular surgery: a randomized prospective trial. Ann Surg 237(6):871–876 discussion 6 PubMedPubMedCentral
44.
Wenger FA, Szucsik E, Hoinoiu BF, Cimpean AM, Ionac M, Raica M (2015) Circular anastomotic experimental fibrin sealant protection in deep colorectal anastomosis in pigs in a randomized 9-day survival study. Int J Colorectal Dis 30(8):1029–1039CrossRefPubMed
45.
Asadi M, Alamdari DH, Rahimi HR, Aliakbarian M, Jangjoo A, Abdollahi A et al (2014) Treatment of life-threatening wounds with a combination of allogenic platelet-rich plasma, fibrin glue and collagen matrix, and a literature review. Exp Ther Med 8(2):423–429CrossRefPubMedPubMedCentral
46.
Akhundov K, Pietramaggiori G, Waselle L, Darwiche S, Guerid S, Scaletta C et al (2012) Development of a cost-effective method for platelet-rich plasma (PRP) preparation for topical wound healing. Ann Burns Fire Disasters 25(4):207–213PubMedPubMedCentral
Metadata
Title
Efficacy and Safety of Pleurodesis Using Platelet-Rich Plasma and Fibrin Glue in Management of Postoperative Chylothorax After Esophagectomy
Authors
Daryoush Hamidi Alamdari
Mehdi Asadi
Ahmad Nejad Rahim
Ghodratollah Maddah
Shahariar Azizi
Soudabeh Shahidsales
Mostafa Mehrabibahar
Publication date
01-04-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 4/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-017-4242-x

Other articles of this Issue 4/2018

World Journal of Surgery 4/2018 Go to the issue

Original Scientific Report

Changes in Swallowing Symptoms and Esophageal Motility After Thyroid Surgery: A Prospective Cohort Study

Original Scientific Report

Preoperative Prognostic Factors After Liver Resection for Non-Colorectal, Non-Neuroendocrine Liver Metastases and Validation of the Adam Score in an Asian Population

Original Scientific Report

Impact of Visceral Adiposity as Well as Sarcopenic Factors on Outcomes in Patients Undergoing Liver Resection for Colorectal Liver Metastases

Original Scientific Report

Living Donor Liver Transplantation in South Asia: Single Center Experience on Intermediate-Term Outcomes

Original Scientific Report

A High Abdominal Aortic Calcification Score on CT is a Risk Factor for Postoperative Pancreatic Fistula in Elderly Patients Undergoing Pancreaticoduodenectomy

Original Scientific Report

Effect and Mechanisms of Diabetes Resolution According to the Range of Gastric Resection and the Length of Anastomosis in Animal Models: Implication for Gastric Cancer Surgery in Patients with Diabetes Mellitus