Retrospective evaluation of seven year chylothorax cases

Aims: Chylothorax is a rare cause of pleural effusion and is a clinical condition with high mortality and morbidity if not treated effectively. Traumatic and malignant causes are the most common etiologies. The most commonly used methods of treatment are conservative and surgical interventions. Surgical treatment has a high success rate. In recent years, interventional applications have become widespread with the increase in the number of centers performing interventional treatment. In our clinic, all three treatment methods were applied separately or together and a retrospective study was planned to reveal the results. Material and Method: Thirty-nine patients who were followed and treated with the diagnosis of chylothorax between 2017 and 2023 at Karadeniz Technical University Faculty of Medicine, Department of Thoracic Surgery were included in the study. The data of the patients were retrospectively identified from their medical records. Data included gender, age, etiology, side, recurrence, chylothorax triglyceride level, total amount of chest tube drainage on the day of diagnosis, duration of treatment, treatment modality and mortality rates. Data were compared with each other and statistically evaluated. Results: When the data of the patients were analyzed, 20 (51.3%) were male and 19 (48.7%) were female, totaling 39 patients. The mean age was 58.2 years. It was rightsided in 66.7%, left-sided in 23.1% and bilateral in 10.3% of the patients. The mean total chest tube drainage on the day of diagnosis was 871.8 dl and the mean triglyceride level was 579.9 mg/dl. When the etiologies were analyzed, 43.6% were iatrogenic, 41% malignancy, 5.1% traumatic, and 10.3% other. Conservative treatment was applied to 30.8%, surgical treatment to 25.6%, interventional treatment to 23.1% and combined treatment to 20.5% of the patients. Most of the patients who underwent surgical and interventional treatment were initially treated conservatively, but the treatment was unsuccessful. Combined treatment included patients in whom surgical and interventional treatments were applied together or who did not benefit from these treatments and were treated again with conservative methods. Of the patients whose treatment was successful, 38.9% benefited from conservative, 36.1% from surgical and 25% from interventional treatment. Conservative treatment was successful in 45.2%, surgical in 76.5% and interventional in 56.3% of patients. Recurrence was seen in 7.7% of the treated patients during follow-up and the recurrences were also treated. The mean duration of treatment was 20.4 days. During the treatment period, 7.7% of the patients were exited and the treatment in these patients was considered unsuccessful. There was a significant correlation between etiology and treatment duration, treatment modality, side, gender and recurrence. No significant correlation was found between treatment modality and treatment duration and mortality. No significant correlation was found between drainage and triglyceride levels and treatment duration and treatment method. Conclusion: The cure rate of patients treated conservatively is close to 50%, but it is not sufficient in many patients. Interventional procedures can be applied in combination with conservative treatment because of the widespread use of interventional centers and because they are less invasive. Considering the problems such as effective visualization and catheterization of the lymphatic system, preoperative intervention may increase the success rate. However, surgery has the highest success rate in chylothorax. Patients who undergo surgery with the right timing and technique have a high chance of cure. In patients whose chylothorax does not resolve after the first surgery, pleurodesis can be applied or a second surgery with chemical and mechanical pleurodesis can be considered. Key words: Chylothorax, conservative, interventional, surgical