Strategic Approach to Massive Chylous Leakage after Neck Dissection

Abstract

(1) Background: A high volume of chylous leakage (>1 L/day) is a potentially lethal complication after neck dissection. However, a strategic treatment for when the leakage progresses from high to massive (>4 L/day) is lacking. (2) Methods: The PubMed database was searched for articles on neck dissection-associated chylous leakage. Nine articles that included 14 cases with >1 L/day chylous leakage (CL) were analyzed. (3) Results: Of the nine patients with 1-4 L/day CL, three were successfully managed with conservative treatment, two with thoracic ductal ligation, three with ductal embolization, and one with local repair with a strap muscle flap. Of the remaining five cases with >4 L/day chylous leakage, three were successfully treated with the pectoralis major myocutaneous flap (PMMF) and one was successfully treated with thoracic ductal ligation and one case died. (4) Conclusions: In this review, when leakage was >4 L/day, the aforementioned interventions were ineffective, but applying the PMMF could rescue the intractable complication. We propose a strategic treatment for high (1-4 L/day) and massive (>4 L/day) chylous leakage.

Keywords: cervical; chyle; cirrhosis; fistula; leak; pectoralis.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of article enrollment.

Figure 2

Strategic approach for neck-surgery-related chylous leakage. CL: chylous leakage; SCM: sternocleidomastoid muscle flap; strap: strap muscle flap; MCT: medium-chain triglycerides diet; TPN: total parenteral nutrition; PMMF: pectoralis major myocutaneous flap; Ductal embolization: lymphangiography for thoracic ductal embolization; Ductal ligation: thoracoscopy for thoracic ductal ligation.