OGC SO30 - Radiological thoracic duct embolisation for post oesophagectomy chyle leak: A single centre retrospective review

Abstract Background Chyle leak is a recognised complication of oesophagectomy associated with increased length of hospital stay, morbidity and is potentially fatal. Chyle leak management is controversial, and lacks a standardised or validated approach. Interventional radiological approaches are well described and routinely able to identify and embolise these thoracic duct leaks reducing need for return to theatre. The aim is to retrospectively evaluate outcomes of lymphangio-embolisation and in patients post Ivor Lewis oesophagectomy for oesophageal carcinoma. Method Data was analysed retrospectively from 168 patients who underwent Ivor Lewis oesophagectomy for oesophageal carcinoma from June 2020 to June 2024, of which 15 patients had chyle leak post operatively. Chyle leak was suspected when chest drain output >500ml in 24 hours and confirmed by high biochemical levels of chylomicrons and triglycerides within the drain fluid. Conservative management involved keeping the patient nil by mouth, total parenteral nutrition and monitoring intercostal drain output. Thoracic duct lymphangiogram was carried out to confirm location of chyle leak-embolisation was carried out using the femoral approach with lipidiol and/or microcoils and/or glue. Results 15 out of 168 (9%) patients had post operative chyle leaks. Four resolved with conservative management within <14 days. 11 chyle leaks persisted after a median of 17 days (range 14-30 days) conservative management and went onto have thoracic duct embolisation. Of those embolised, six chyle leaks resolved within three days post procedure. Two resolved 5-7 days post embolization. One had repeat embolization seven days post primary embolisation. Two patients required thoracoscopic ligation of thoracic duct, due to obesity making embolisation technically impossible and lack of interventional radiology capacity respectively. No patients had adverse outcomes. Conclusion Thoracic duct embolisation is an effective and safe approach for routine management of post oesophagectomy chyle leaks and may reduce return to theatre.