Laparoscopic thoracic duct clipping for persistent chylothorax after extrapleural pneumonectomy

Our plain-English summary of Laparoscopic thoracic duct clipping for persistent chylothorax after extrapleural pneumonectomy, by N. Tsubokawa, Y. Hamai, J. Hihara, et al (The Annals of Thoracic Surgery, 2012).

The study

• Authors: N. Tsubokawa, Y. Hamai, J. Hihara, M. Emi, Y. Miyata, M. Okada
• Journal: The Annals of Thoracic Surgery
• Published: 2012;93(5):e131-2
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We describe a 68-year-old man who was treated by laparoscopic thoracic duct clipping for persistent chylothorax after an extrapleural pneumonectomy for malignant pleural mesothelioma. Initial conservative treatment did not resolve the postoperative chylothorax. A second surgery through the thoracic approach was considered invasive and difficult after extrapleural pneumonectomy. A laparoscopic approach proved effective and resolved the chylothorax. Thus, laparoscopic thoracic duct clipping is considered very useful for treating chylothorax.

Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This article was a case report about one 68-year-old man in Hiroshima, Japan, who had a history of asbestos exposure and was diagnosed with epithelial malignant pleural mesothelioma in the left chest. He received 3 cycles of induction chemotherapy with cisplatin and pemetrexed. He then had a left extrapleural pneumonectomy, an operation removing the lung and lining, with parts of the chest wall, diaphragm and pericardium. The authors reported complete resection. Starting on postoperative day 4, he developed chylothorax, a leak of lymph fluid into the chest, with daily drainage of over 1,500 mL. Diet changes, drainage and intravenous nutrition did not resolve it, and the leak returned after the chest tube was removed. Because operating again through either side of the chest was judged difficult and invasive, surgeons clipped the thoracic duct through the abdomen by laparoscopy on postoperative day 37. The fluid then decreased, and the chest tube was removed 7 days later. The authors concluded that laparoscopic thoracic duct clipping is a useful option for managing chylothorax, particularly when a chest approach is unsuitable.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report
• Who was studied: One 68-year-old man with a history of asbestos exposure, diagnosed with epithelial malignant pleural mesothelioma of the left pleura, treated at Hiroshima University, Japan
• Exposure: A history of exposure to asbestos; the article gives no fiber type, job, product or dose. The report is mainly about surgical treatment of a complication after extrapleural pneumonectomy.
• Main results:
  • The patient's biopsy diagnosis was epithelial malignant pleural mesothelioma.
  • The patient received 3 cycles of induction chemotherapy with cisplatin 75 mg/m2 and pemetrexed 500 mg/m2, each on day 1.
  • Left extrapleural pneumonectomy with resection of parts of the chest wall, diaphragm and pericardium achieved complete resection.
  • Postoperative chylothorax was diagnosed from milky drainage of over 1,500 mL per day after oral intake, evident on postoperative day 4.
  • Conservative treatment (low-fat diet with medium chain triglycerides, drainage, intravenous nutrition) did not succeed, and drainage had to be repeated on postoperative day 29.
  • The thoracic duct was clipped laparoscopically through the abdomen on postoperative day 37, to avoid surgery through either side of the chest.
  • After clipping, the pleural effusion decreased and the chest tube was removed 7 days after the second surgery.
• The authors' conclusion: The authors concluded that laparoscopic thoracic duct clipping is a useful option for managing chylothorax, particularly when a thoracic approach is unsuitable.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Extrapleural Pneumonectomy (EPP), Pleural Mesothelioma.

Related studies

• Treatment of postoperative chylothorax through laparoscopic thoracic duct ligation — B.C. Vassallo, D. Cavadas, et al. (2002)
• Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma — M. Egan, B.E. Louie, et al. (2012)
• Second surgery for recurrence of malignant pleural mesothelioma after extrapleural pneumonectomy — L. Politi, G. Borzellino (2010)
• Patterns of failure, toxicity, and survival after extrapleural pneumonectomy and hemithoracic intensity-modulated radiation therapy for malignant pleural mesothelioma — D.R. Gomez, D.S. Hong, et al. (2013)
• Constrictive pericarditis after left extrapleural pneumonectomy and radiotherapy for malignant mesothelioma — E.J. Hickey, A.A. Khan, et al. (2007)
• Spinal cord ischemia resulting in paraplegia following extrapleural pneumonectomy — K. Ural, K. Jakob, et al. (2014)

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