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09-07-2021 | Neck Dissection | Original Article

Role of Octreotide in Conservative Management of Chyle Leak Post Neck Dissection in Cases of Head Neck Cancer: A Retrospective Analysis

Authors: Vikas Gupta, Gunjan Dwivedi, Rajeev Chugh, Pankaj Kumar Sahu, Devendra Kumar Gupta, Abhijit Basu, Kiran Upadhyay, Uma Patnaik, Ritika Bhatia

Published in: Indian Journal of Otolaryngology and Head & Neck Surgery | Special Issue 3/2022

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Abstract

Chyle leak is a dreadful complication in patients undergoing neck dissections. Octreotide has been used in the management of chyle leak post neck dissections in head and neck cancer patients. Currently there is no consensus and practice guidelines on the same. (1) To study the role of octreotide in early cessation of post neck dissection chyle leak. (2) To study incidence of intra-operative and post-operative CL, its relation to the extent of nodal disease and neck dissection, prior radiotherapy. Retrospective analysis of 16 patients out of 529 neck dissection over a period of 03 years between Jan 2016 and Dec 2019 who developed post-operative chyle leak. All patients who had post-operative chyle leak were administered octreotide. Time taken for chyle leak to stop was primary outcome. Secondary outcomes were duration of hospitalization post-operatively, incidence of intra-operative and post-operative chyle leak, its relation to the extent of nodal disease, prior radiotherapy and type of neck dissection. 59 of 529 neck dissections (11.15%) were noted to have intra-operative chyle leak. 16 of 529 neck dissections (3.02%) developed post-operative chyle leak. On applying chi square test, prior multimodality and N plus neck were found to be significant risk factors in developing postoperative chyle leak. Considering only RT versus no RT in prior multimodality treated group, the difference was insignificant. Onset of chyle leak varied from 1 to 5 post-op day (mean 2.68 days). 15 (93.75%) patients responded to octreotide. Chyle leak resolved between 3 and 10 days (mean 5.18 days) and octreotide was given for 5–12 days (mean-7.18 days). Overall duration of hospitalization ranged from 09 to 18 days (mean 12.18 days). 01 patient (6.25%) had to be re-explored due to high volume leak despite using octreotide. Adverse effects of octreotide were minimal and tolerable. Octreotide is effective in reducing the duration of chyle leak, hospital stay and need for surgical intervention. It may be considered as suitable adjunct to conservative measures in the management for post-operative chyle leak.
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Metadata
Title
Role of Octreotide in Conservative Management of Chyle Leak Post Neck Dissection in Cases of Head Neck Cancer: A Retrospective Analysis
Authors
Vikas Gupta
Gunjan Dwivedi
Rajeev Chugh
Pankaj Kumar Sahu
Devendra Kumar Gupta
Abhijit Basu
Kiran Upadhyay
Uma Patnaik
Ritika Bhatia
Publication date
09-07-2021
Publisher
Springer India
Keyword
Neck Dissection
Published in
Indian Journal of Otolaryngology and Head & Neck Surgery / Issue Special Issue 3/2022
Print ISSN: 2231-3796
Electronic ISSN: 0973-7707
DOI
https://doi.org/10.1007/s12070-021-02746-y