• Nathaniel Deboever, Arlene M Correa, Hope Feldman, Michael Eisenberg, Mara B Antonoff, Reza J Mehran, Ravi Rajaram, David C Rice, Jack A Roth, Boris Sepesi, Stephen G Swisher, Ara A Vaporciyan, Garrett L Walsh, and Wayne L Hofstetter.
• Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, University of Texas, Holcombe Boulevard, Houston, TX.
• Ann. Surg. 2024 Jul 1; 280 (1): 919791-97.

ObjectiveTo investigate overall survival and length of stay (LOS) associated with differing management for high output (>1 L over 24 hours) leaks (HOCL) after cancer-related esophagectomy.BackgroundAlthough infrequent, chyle leak after esophagectomy is an event that can lead to significant perioperative sequelae. Low-volume leaks appear to respond to nonoperative measures, whereas HOCLs often require invasive therapeutic interventions.MethodsFrom a prospective single-institution database, we retrospectively reviewed patients treated from 2001 to 2021 who underwent esophagectomy for esophageal cancer. Within that cohort, we focused on a subgroup of patients who manifested a HOCL postoperatively. Clinicopathologic and operative characteristics were collected, including hospital LOS and survival data.ResultsA total of 53/2299 patients manifested a HOCL. These were mostly males (77%), with a mean age of 62 years. Of this group, 15 patients received nonoperative management, 15 patients received prompt (<72 hours from diagnosis) interventional management, and 23 received late interventional management. Patients in the late intervention group had longer LOSs compared with early intervention (slope = 9.849, 95% CI: 3.431-16.267). Late intervention (hazard ratio: 4.772, CI: 1.384-16.460) and nonoperative management (hazard ratio: 4.731, CI: 1.294-17.305) were associated with increased mortality compared with early intervention. Patients with early intervention for HOCL had an overall survival similar to patients without chyle leaks in survival analysis.ConclusionsPatients with HOCL should receive early intervention to possibly reverse the prognostic implications of this potentially detrimental complication.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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