Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment?

Department of Surgical Oncology, Paul Strauss Cancer Center, Strasbourg, France.
Case Reports in Oncology 05/2011; 4(2):255-9. DOI: 10.1159/000328801
Source: PubMed


The use of somatostatin analogs is a new conservative therapeutic approach for the treatment of chyle fistulas developing after thyroid cancer surgery. The combination therapy with a total parenteral nutrition should avoid the high morbidity of a re-intervention with an uncertain outcome. This promising trend is supported by the present case report of a chyle leak occurring after total thyroidectomy with central and lateral neck dissection for a papillary carcinoma, which was treated successfully without immediate or distant sequelae.

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Available from: Frederic Bodin, Mar 10, 2014
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    • "Ligation should be undertaken either by ligature or by suture in cases where the leak is identified Intraoperatively. Thoracoscopic approaches have also been successfully used as minimally invasive modalities of postoperative chyle leak surgical management Fig. 1 – Flow diagram for chyle leak management [12] [14] [19] (TPN; total parenteral nutrient, MCT; medium chain triglycerides) o t o l a r y n g o l o g i a p o l s k a 6 8 ( 2 0 1 4 ) 2 0 4 – 2 0 7 [17] [18]. The presented case was a low output chyle leak that responded well to conservative management. "
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    ABSTRACT: Background Thyroidectomy is one of the common neck surgeries. Well recognized complications include postoperative bleeding, hypocalcaemia and recurrent laryngeal nerve injury. Chyle leak post-thyroidectomy is extremely rare. Most of the reported cases have had a complete central compartment neck dissection. Methods and results This is a case report of a patient who suffered from chyle leak after a left hemithyroidectomy without a complete central compartment neck dissection. The patient was managed conservatively with low fat diet and observation. A protocol for approaching thyroid patients with chyle leak is proposed based on a comprehensive literature review. Conclusion Chyle leak post-thyroidectomy for a benign disease is a very rare complication. Nevertheless, head and neck surgeons should consider it in the differential diagnosis of neck swelling post-thyroidectomy.
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    ABSTRACT: Iatrogenic chyle leak with chyloma formation in the neck is a rare complication of neck dissection resulting from injury to the thoracic duct. We present the case of a 37-year-old woman who complained of left-sided neck swelling within days after total thyroidectomy and lateral neck dissection for papillary thyroid cancer. Lymphoscintigraphy demonstrated the chyle leak in the left cervical region, and subsequent aspiration of the left neck swelling showed radioactivity in the aspirate. After successful operative repair of the thoracic duct, the patient was able to undergo radioactive ablative thyroid treatment.
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    ABSTRACT: Chylothorax is a rare complication of neck dissection, and bilateral chylothorax is even more rare. However, both are potentially serious and sometimes life threatening, especially those that are associated with left neck dissection for head and neck neoplasms. We report one case of bilateral chylothorax following left supraclavicular dissection for breast cancer. This case was treated successfully with a new conservative management approach.
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