Chylous Fistula after Surgery for Papillary Thyroid Carcinoma

Park, Jong Dae; Hong, Suck Joon

Abstract

PURPOSE
Most of postoperative chylous fistula in the neck occur after lateral neck lymph node dissection. However we experienced chylous fistulas in the central neck as well as lateral neck after surgery for papillary thyroid carcinoma. Herein we reviewed our experience of chylous fistula and tried to make guideline for the decision of optimal treatment in the early period of chylous fistula.
METHODS
We retrospectively reviewed our thyroidectomy cases for the papillary thyroid carcinoma with central neck node dissection (n: 1220) and left neck node dissection (n: 149) over a period of 6years. In 17 patients, a chylous fistula was occurred, 8 in the lateral neck, 9 in the central neck. The treatment method, daily output, and the hospital course of the chylous fistula were analysed.
RESULTS
The incidence of chylous fistula after lymph node dissection in the central neck and lateral neck was 0.7% and 5.4% respectively. All 9 central neck fistulas were successfully treated with conservative treatment . 6 lateral neck fistulas were also treated successfully with conservative treatment including medium chain triglyceride treatment and compression dressing. In 2 lateral neck fistulas, operative management was required, one due to poor response to conservative management and metabolic derrangement, another one due to large amount of daily output in the early post operative days. The maximal daily output of conservative management group and operative management group were below 250 cc/day and over 1,800 cc/day respectively.
CONCLUSION
The chylous fistula in the neck could be occurred not only after lateral neck dissection but also after central neck dissection, although the clinical course of central neck fistula was relatively benign. Most of chylous fistulas could be treated conservatively. However, in the early high output fistula (over 1,800 cc/day) cases, prompt operative management should be considered for the prevention of metabolic derrangement and shortening the hospital course.