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Journal of Cardiothoracic Surgery

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Open Access 01-12-2021 | Pleural Effusion | Research article

Treatment of Chylothorax complicating pulmonary resection with hypertonic glucose Pleurodesis

Authors: Kejian Zhang, Changyuan Li, Mingrui Zhang, Yang Li

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

Abstract

Background

To retrospectively assess the efficacy of hypertonic glucose pleurodesis for treatment of chylothorax after pulmonary resection.

Methods

Out of a total of 8252 patients who underwent pulmonary resection (at least lobectomy) at department of thoracic surgery, between June 2008 and December 2015, 58 patients (0.7%) developed postoperative chylothorax. All patients received conservative treatment, including thoracic closed drainage, oral fasting, and total parenteral nutrition.

Results

Conservative treatment was successful in 50 (86.2%) patients, while eight patients [mean age: 58.0 years (range, 45–75)] were treated with hypertonic glucose pleurodesis. All eight patients had undergone operation for lung cancer (four squamous cell carcinomas and four adenocarcinomas). The bronchial stump was covered by pleural flap in three patients. After pleurodesis, three patients developed fever but without empyema; thoracentesis was performed in two patients. The mean time interval between pleurodesis and operation was 4.3 days (range,3–5) days. The average length of stay was 23.1 days (range, 18–31). No recurrent pleural effusion was observed over a mean follow-up duration of 28 months.

Conclusion

Hypertonic glucose pleurodesis performed via the chest drainage tube is a viable treatment option for chylothorax after lung resection, prior to resorting to a thoracoscopic or thoracotomic ductus thoracicus ligation of the thoracic duct leak. It is a simple, safe and efficient modality associated with rapid recovery and less pain.

Ziarnik E, Grogan EL. Postlobectomy early complications. Thorac Surg Clin. 2015;25(3):355–64. https://doi.org/10.1016/j.thorsurg.2015.04.003.CrossRefPubMedPubMedCentral

Nair SK, Petko M, Hayward MP. Aetiology and management of chylothorax in adults. Eur J Cardiothorac Surg. 2007;32(2):362–9. https://doi.org/10.1016/j.ejcts.2007.04.024.CrossRefPubMed

Nakano A, Kato M, Watanabe T, Kawai N, Ota H, Hattori T, et al. OK-432 chemical pleurodesis for the treatment of persistent chylothorax. Hepatogastroenterology. 1994;41(6):568–70.PubMed

Brissaud O, Desfrere L, Mohsen R, Fayon M, Demarquez JL. Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (betadine). Arch Dis Child Fetal Neonatal Ed. 2003;88(6):F531–3. https://doi.org/10.1136/fn.88.6.F531.CrossRefPubMedPubMedCentral

Christodoulou M, Ris HB, Pezzetta E. Video-assisted right supradiaphragmatic thoracic duct ligation for non-traumatic recurrent chylothorax. Eur J Cardiothorac Surg. 2006;29(5):810–4. https://doi.org/10.1016/j.ejcts.2006.01.064.CrossRefPubMed

Roehr CC, Jung A, Proquitte H, Blankenstein O, Hammer H, Lakhoo K, et al. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med. 2006;32(5):650–7. https://doi.org/10.1007/s00134-006-0114-9.CrossRefPubMed

Hoffer EK, Bloch RD, Mulligan MS, Borsa JJ, Fontaine AB. Treatment of chylothorax: percutaneous catheterization and embolization of the thoracic duct. AJR Am J Roentgenol. 2001;176(4):1040–2. https://doi.org/10.2214/ajr.176.4.1761040.CrossRefPubMed

Gomez-Caro Andres A, Marron Fernandez C, Moradiellos Diez FJ, Diaz-Hellin Gude V, Perez Anton JA, Martin de Nicolas JL. Octreotide for conservative management of postoperative chylothorax. Arch Bronconeumol. 2004;40(10):473–5. https://doi.org/10.1016/S1579-2129(06)60357-1.CrossRefPubMed

Fahimi H, Casselman FP, Mariani MA, van Boven WJ, Knaepen PJ, van Swieten HA. Current management of postoperative chylothorax. Ann Thorac Surg. 2001;71(2):448–50; discussion 50-1. https://doi.org/10.1016/S0003-4975(00)02033-6.CrossRefPubMed

10.

Thompson KJ, Kernstine KH, Grannis FW Jr, Mojica P, Falabella A. Treatment of chylothorax by robotic thoracic duct ligation. Ann Thorac Surg. 2008;85(1):334–6. https://doi.org/10.1016/j.athoracsur.2007.04.109.CrossRefPubMed

11.

Takeo S, Yamazaki K, Takagi M, Nakashima A. Thoracoscopic ultrasonic coagulation of thoracic duct in management of postoperative chylothorax. Ann Thorac Surg. 2002;74(1):263–5. https://doi.org/10.1016/S0003-4975(02)03463-X.CrossRefPubMed

12.

Ammori JB, Pickens A, Chang AC, Orringer MB. Tension chylothorax. Ann Thorac Surg. 2006;82(2):729–30. https://doi.org/10.1016/j.athoracsur.2005.10.033.CrossRefPubMed

13.

Suemitsu R, Ondo K, Fukuyama S, Ueda H. Late-period-onset chylothorax after a pulmonary resection for lung cancer: a case report. Ann Thorac Cardiovasc Surg. 2007;13(5):345–8.PubMed

14.

Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC. Postoperative chylothorax. J Thorac Cardiovasc Surg. 1996;112(5):1361–5; discussion 5-6. https://doi.org/10.1016/S0022-5223(96)70152-6.CrossRefPubMed

15.

Le Pimpec-Barthes F, D'Attellis N, Dujon A, Legman P, Riquet M. Chylothorax complicating pulmonary resection. Ann Thorac Surg. 2002;73(6):1714–9. https://doi.org/10.1016/S0003-4975(02)03570-1.CrossRefPubMed

16.

Shimizu K, Yoshida J, Nishimura M, Takamochi K, Nakahara R, Nagai K. Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg. 2002;124(3):499–502. https://doi.org/10.1067/mtc.2002.124386.CrossRefPubMed

17.

Johnstone DW. Postoperative chylothorax. Chest Surg Clin N Am. 2002;12(3):597–603, vii. https://doi.org/10.1016/S1052-3359(02)00016-9.CrossRefPubMed

18.

Aoki M, Kato F, Saito H, Mimatsu K, Iwata H. Successful treatment of chylothorax by bleomycin for Gorham's disease. Clin Orthop Relat Res. 1996;330:193–7. https://doi.org/10.1097/00003086-199609000-00025.CrossRef

19.

Tsukioka T, Inoue K, Oka H, Mizuguchi S, Morita R, Nishiyama N. Intraoperative mechanical and chemical pleurodesis with 50% glucose solution for secondary spontaneous pneumothorax in patients with pulmonary emphysema. Surg Today. 2013;43(8):889–93. https://doi.org/10.1007/s00595-013-0497-5.CrossRefPubMed

20.

Wei GN, Mao JH. Hypertonic glucose pleurodesis and surgical diaphragmatic repair for tension hydrothorax complicating continuous ambulatory peritoneal dialysis. Clin Nephrol. 2016;85(5):301–4. https://doi.org/10.5414/CN108590.CrossRefPubMed

Title: Treatment of Chylothorax complicating pulmonary resection with hypertonic glucose Pleurodesis
Authors: Kejian Zhang
Changyuan Li
Mingrui Zhang
Yang Li
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Pleural Effusion
Pleurodesis
Pneumonectomy
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01462-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment of Chylothorax complicating pulmonary resection with hypertonic glucose Pleurodesis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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