J Breast Cancer.  2012 Mar;15(1):133-134. 10.4048/jbc.2012.15.1.133.

Chylous Leakage: A Rare Complication after Axillary Lymph Node Dissection in Breast Cancer and Surgical Management

• Baek JM
• Lee JA
• Nam YH
• Sung GY
• Lee DS
• Won JM

• KMID: 2286486
• DOI: http://doi.org/10.4048/jbc.2012.15.1.133

Abstract

Chylous leakage is an extremely rare complication of surgery for breast cancer. We experienced a case of chylous leakage after axillary lymph node dissection. A 38-year-old woman with invasive ductal carcinoma in the left breast underwent a modified radical mastectomy after four cycles of neoadjuvant chemotherapy. The postoperative serosanguinous drainage fluid became "milky" on the fourth postoperative day. After trying conservative management, we re-explored the axilla and ligated the lymphatic trunk. Although the success of many cases supports conservative management, timely surgical intervention represents an alternative in cases where leakage persists or where the output is high.

Keyword

Breast neoplasms; Chyle; Lymph node excision; Surgical procedures

MeSH Terms

Adult
Axilla
Breast
Breast Neoplasms
Carcinoma, Ductal
Chyle
Drainage
Female
Humans
Lymph Node Excision
Lymph Nodes
Mastectomy, Modified Radical

Figure

• 

  Figure 1 Operative findings. The clear fluid is running from one duct (black arrow).

Reference

1. Merrigan BA, Winter DC, O'Sullivan GC. Chylothorax. Br J Surg. 1997. 84:15–20.

2. Fitz-Hugh GS, Cowgill R. Chylous fistula. Arch Otolaryngol. 1970. 91:543–547.

3. Nakajima E, Iwata H, Iwase T, Murai H, Mizutani M, Miura S, et al. Four cases of chylous fistula after breast cancer resection. Breast Cancer Res Treat. 2004. 83:11–14.

4. Gottlieb MI, Greenfield J. Variations in the terminal portion of the human thoracic duct. AMA Arch Surg. 1956. 73:955–959.

5. Shimada K, Sato I. Morphological and histological analysis of the thoracic duct at the jugulo-subclavian junction in Japanese cadavers. Clin Anat. 1997. 10:163–172.

6. Purkayastha J, Hazarika S, Deo SV, Kar M, Shukla NK. Post-mastectomy chylous fistula: anatomical and clinical implications. Clin Anat. 2004. 17:413–415.

7. Abdelrazeq AS. Lymphoscintigraphic demonstration of chylous leak after axillary lymph node dissection. Clin Nucl Med. 2005. 30:299–301.

8. Abe M, Iwase T, Takeuchi T, Murai H, Miura S. A randomized controlled trial on the prevention of seroma after partial or total mastectomy and axillary lymph node dissection. Breast Cancer. 1998. 5:67–69.

9. Caluwe GL, Christiaens MR. Chylous leak: a rare complication after axillary lymph node dissection. Acta Chir Belg. 2003. 103:217–218.

10. Spiro JD, Spiro RH, Strong EW. The management of chyle fistula. Laryngoscope. 1990. 100:771–774.