Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for XXXX .

@entity1 @entity2
OBJECTIVE: We reviewed our experience with iatrogenic chylothorax after pulmonary resections for @entity2 to evaluate our treatment strategy and to identify factors that predict the need for reoperation. METHODS: From July 1992 through February 2000, a total of 1110 @entity1 underwent pulmonary resection (at least lobectomy) and systematic mediastinal lymph node dissection for @entity2 at our division. Twenty-seven @entity1 (2.4%) had postoperative chylothorax develop. We initially treated 26 of these @entity1 conservatively with complete oral intake cessation and total parenteral nutrition, and these @entity1 constituted the subjects in this study. RESULTS: There were 21 @entity1 and 5 @entity1 with a median age of 62 years (range 44 to 80 years). The initial procedures were pneumonectomy in 2 cases, bilobectomy in 1 case, and lobectomy in 23 cases. Twenty-one @entity1 (81%) had the condition cured with conservative treatment. These @entity1 resumed a normal diet at a median of 8 days after chylothorax diagnosis (range 4-35 days). The remaining 5 @entity1 (19%) underwent reoperation at a median of 14 days after diagnosis (range 5-35 days). Chest tube drainage of less than 500 mL during the first 24 hours after complete oral intake cessation and total parenteral nutrition predicted a cure with conservative treatment. CONCLUSION: Although most cases of chylothorax after pulmonary resection with systematic mediastinal lymph node dissection can be cured with a conservative strategy, early surgical intervention may be indicated if chest tube drainage is more than 500 mL during the first 24 hours after complete oral intake cessation and total parenteral nutrition.
