Non-Prophylactic Thoracic Duct Ligation May Be Favorable Prognosis Factor For Post-Esophagectomy Chylous Leakage Undergoing Lymphangiography

Purpose: To determine the clinical factors that affect therapeutic effects of lymphangiography (LAG) on post-esophagectomy chylous leakage. Methods: We retrospectively reviewed 1198 patients undergoing esophagectomy from 2007 to 2017 in our hospital. Two patients with post-esophagectomy chylous leakage undergoing LAG were identified. One patient received non-prophylactic thoracic duct ligation during esophagectomy and was cured by LAG after non-effective conservative treatment. Another patient was prophylactically ligated and failed to be cured by LAG but cured by re-surgery. The clinical course of these patients was compared to reveal the factors related to the therapeutic effects of LAG for post-esophagectomy chylous leakage. Furthermore, we conducted a systematic literature review in four English databases (EMBASE, OVID, ISI Web of Science, and PubMed) with the date from January 2000 to December 2018 to summarize the lymphangiography management of post-esophagectomy chylous leakage. Combining with our study, a total of 15 studies containing 42 cases were included. Results: After comparing the clinical course of the two cases in our study, we speculated that LAG was more therapeutically effective for post-esophagectomy chylous leakage in patients without prophylactic thoracic duct ligation. Analysis of the cases from our study and the previous studies suggested that the patients without prophylactic thoracic duct ligation needed less reoperation than those with thoracic duct ligation (9.09% versus 53.33%) after LAG management. And the patients with 500 ml/d pleural effusion (PE) before LAG were more likely to be healed by LAG alone than those with 500-1000 ml/d or e 1000 ml/d PE before LAG (76.92% versus 35.71% and 14.29%). Conclusions: Non-prophylactic thoracic duct ligation and less PE might be favorable factors in predicting therapeutic effects of LAG in chylous leakage after esophagectomy.