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Chyle Leakage in Patients Undergoing Thyroidectomy Plus Central Neck Dissection for Differentiated Papillary Thyroid Carcinoma

¹ Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea
² Department of Otolaryngology–Head and Neck Surgery, Chungnam National University College of Medicine, 640 Daesa-Dong, Chung-Gu, Daejeon 301-040, Republic of Korea

Correspondence: Address correspondence and reprint requests to: Jong-Lyel Roh, MD, PhD; E-mail: rohjl{at}amc.seoul.kr

Background: Chyle leakage is an uncommon complication of lateral neck dissection for metastatic papillary thyroid carcinoma (PTC). There have been no reports on chyle leakage after central neck dissection not combined with lateral neck dissection. We therefore investigated chyle leakage in PTC patients undergoing thyroidectomy and central neck dissection.

Methods: A total of 283 new patients with differentiated PTC underwent total thyroidectomy plus central neck dissection. The amount and duration of drain leakage, and the concentrations of triglycerides and cholesterol in drain fluid and serum were measured in patients who had suspected postoperative chyle leakage. The incidence and management of chyle leakage were analyzed.

Results: Intraoperative chyle leakage was not found in any patient, although postoperative leakage was detected in four patients (1.4%). Mean ± standard deviation peak 24-hour drainage was 122 ± 57 mL, and duration of leakage was 10 ± 7 days. Mean triglyceride concentration of drainage fluid was 433 ± 182 mg/dL. These patients were treated with pressure dressings and a medium-chain triglyceride diet. One patient underwent intralesional injection of OK-432 for localized chyle accumulation. All chyle leakages stopped after conservative management without surgical intervention.

Conclusion: Chyle leakage can occur after thyroidectomy and central neck dissection not combined with lateral neck dissection. These findings will aid in the recognition and treatment of this uncommon complication during the early postoperative period.

Key Words: Papillary thyroid carcinoma • Central neck dissection • Chyle leakage • Incidence • Management