Early Interventional Treatment of High Output Chyle Leak following Esophagectomy is Associated with Improved Survival
Presented During:
Saturday, May 6, 2023: 8:00AM - Tuesday, May 9, 2023: 11:45AM
Los Angeles Convention Center
Posted Room Name:
Outside of Room 408
Abstract No:
PS055
Submission Type:
Abstract Submission
Authors:
Nathaniel Deboever (1), Arlene Correa (2), Hope Feldman (2), Michael Eisenberg (2), Mara Antonoff (3), Reza Mehran (2), Ravi Rajaram (2), David Rice (2), Jack Roth (2), Boris Sepesi (2), Stephen Swisher (2), Ara Vaporciyan (2), Garrett Walsh (2), Wayne Hofstetter (4)
Institutions:
(1) Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, houston, TX, (2) Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, (3) Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Bellaire, TX, (4) Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houstom, TX
Submitting Author:
Nathaniel Deboever
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Co-Author(s):
Arlene Correa
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Hope Feldman
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Michael Eisenberg
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
*Mara Antonoff
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
*Reza Mehran
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Ravi Rajaram
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
*David Rice
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Jack Roth
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Boris Sepesi
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
*Stephen Swisher
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
*Ara Vaporciyan, MD
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
*Garrett Walsh
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
*Wayne Hofstetter
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Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center
Presenting Author:
Nathaniel Deboever
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Abstract:
Objective: Chylothorax following esophagectomy can lead to significant sequelae. Low volume leaks often respond to non-operative measures, while high output (>1 liter over 24 hours) leaks (HOL) may require invasive interventions. Our objective was to investigate various therapeutic approaches and their effect on length of stay (LOS) and overall survival (OS).
Methods: From a prospective single-institution database, we retrospectively reviewed patients treated from 2001-2021 who underwent esophagectomy for esophageal cancer and manifested a HOL. Clinicopathologic and operative characteristics were collected, as were hospital LOS and OS data. Early intervention was defined as receiving a procedure within 72 hours of HOL diagnosis. Late intervention occurred beyond 72 hours, and conservative management encompassed patients managed without intervention. A Cox multivariate model, and a multivariate linear regression were built to investigate the effect of HOL management on OS, and LOS, respectively. The Kaplan Meier method was used to compare length of stay based on timing and type of treatment for chylothorax.
Results: A total of 53/2299 patients, most of whom were male (77%) with a median age of 62 years, manifested a HOL. Most resections were performed in an open manner (n=51, 96.2%). Of this group, 15 patients received non-operative management, 15 and 23 patients received early interventional management and late interventional management, respectively. The median overall survival in patients with HOL was 40.3 months (IQR: 12.0-51.7). Late intervention (Hazard Ratio (HR) 4.772, CI: 1.384 to 16.460) and non-operative management (HR 4.731, CI: 1.294 to 17.305) were associated with increased mortality compared to early intervention. The median length of stay in patients with HOL was 19 days (IQR: 13-29). Patients in the late intervention group had longer length of stay compared to early intervention (Regression Coefficient=9.849, 95% Confidence Interval [CI] 3.431 to 16.267). Patients with early intervention for HOL had an OS similar to patients without chyle leaks in Kaplan Meier analysis (Figure).
Conclusions: Development of chylothorax following esophagectomy is associated with high morbidity. Patients with HOL should receive early operative intervention within the first 72 hours in order to combat the potential deleterious outcomes of delayed treatment and their associated prognostic implications, including prolonged LOS and decreased OS.
Methods: From a prospective single-institution database, we retrospectively reviewed patients treated from 2001-2021 who underwent esophagectomy for esophageal cancer and manifested a HOL. Clinicopathologic and operative characteristics were collected, as were hospital LOS and OS data. Early intervention was defined as receiving a procedure within 72 hours of HOL diagnosis. Late intervention occurred beyond 72 hours, and conservative management encompassed patients managed without intervention. A Cox multivariate model, and a multivariate linear regression were built to investigate the effect of HOL management on OS, and LOS, respectively. The Kaplan Meier method was used to compare length of stay based on timing and type of treatment for chylothorax.
Results: A total of 53/2299 patients, most of whom were male (77%) with a median age of 62 years, manifested a HOL. Most resections were performed in an open manner (n=51, 96.2%). Of this group, 15 patients received non-operative management, 15 and 23 patients received early interventional management and late interventional management, respectively. The median overall survival in patients with HOL was 40.3 months (IQR: 12.0-51.7). Late intervention (Hazard Ratio (HR) 4.772, CI: 1.384 to 16.460) and non-operative management (HR 4.731, CI: 1.294 to 17.305) were associated with increased mortality compared to early intervention. The median length of stay in patients with HOL was 19 days (IQR: 13-29). Patients in the late intervention group had longer length of stay compared to early intervention (Regression Coefficient=9.849, 95% Confidence Interval [CI] 3.431 to 16.267). Patients with early intervention for HOL had an OS similar to patients without chyle leaks in Kaplan Meier analysis (Figure).
Conclusions: Development of chylothorax following esophagectomy is associated with high morbidity. Patients with HOL should receive early operative intervention within the first 72 hours in order to combat the potential deleterious outcomes of delayed treatment and their associated prognostic implications, including prolonged LOS and decreased OS.
THORACIC:
Esophageal Cancer
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