Therapeutic Strategy for Chylothorax After Esophagectomy: Lymphangiography with an Inguinal Intranodal Approach

Chylothorax after esophagectomy typically receives conservative treatment first, but chylothorax can be resistant to such measures and sometimes requires surgical treatment. Depiction of the thoracic duct and identification of the leak point are important when deciding whether surgical intervention is necessary for the therapeutic management of chylothorax. The study included 6 patients with persistent chylothorax after esophagectomy at our institution from 2014 to 2018. These six patients underwent lymphangiography with an inguinal intranodal approach. We retrospectively examined their records and evaluated the efficacy and safety of this technique. Lymphangiography with an inguinal intranodal approach was successful in depicting the thoracic duct in all cases. In addition, identification of the chyle leak was possible in all cases. No complications of this method were observed. Four of the 6 patients showed a marked decrease in chylous effusion within 2 days and were cured by the lymphangiography itself. However, 2 cases required surgical thoracic duct ligation. In the two cases that underwent surgery, the thoracic duct on the cranial side of the leak point was not depicted by lymphangiography, and the thoracic duct itself was leaking. This method is effective not only for identifying the chyle leak point but also for treating chylothorax. Moreover, it helps clarify the indications for surgical thoracic duct ligation. This minimally invasive and safe method may be an option for treatment of chylothorax after esophagectomy.