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<p>A rare but serious complication of neck dissections is chyle leak (CL), which can cause electrolyte disturbances, protein loss, local infection and rarely sepsis and mortality. There is lack of consensus to choose among the various management strategies. In this study, we report our experience at a tertiary cancer center in managing CL and propose an algorithm for its management. This is a retrospective review of a prospectively maintained surgical morbidity database, between 2015 to 2020. We analysed 8499 lateral cervical neck dissections involving level IV neck dissections. We studied the incidence, risk factors, clinical course of post-operative CL, and also the outcomes of conventional vs surgical management. The overall incidence of chyle leak in our institution was 2.65% (n-223), of which 83.4% was left-sided. 62.8% cases occurred in patients requiring therapeutic neck dissection (cN +). Of the entire cohort, (85.7%) had low output leaks, 91% were managed conservatively. Median duration of hospitalization for the entire cohort was 11&#xa0;days. 20 cases required surgical exploration (8.96%), of these 18 (90%) were high output CLs. The amount of the daily drain output (high vs low) was significant in predicting the need for surgical exploration. Most patients with low output (&lt; 500&#xa0;ml) CL respond to conservative management with fat free diet and Medium chain triglycerides (MCT). Patients with high output CLs may benefit from early surgical or interventional management, reducing duration of inpatient stay and preventing its sequelae. Utility of other non-surgical and interventional management modalities, and their comparison with conservative measures, needs to be further studied.</p>

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Implications for Clinical Management of Chyle Leak: A Single Institutional Experience in 8499 Neck Dissections

  • 期刊论文

  • 发表日期：

    2026年3月13日

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  • Kartik V. Krishnan,
  • Prathamesh Pai,
  • Vidisha Tuljapurkar,
  • Gouri Pantvaidya,
  • Anuja Deshmukh,
  • Devendra Chaukar,
  • Shivakumar Thiagarajan,
  • Richa Vaish,
  • Pankaj Chaturvedi,
  • Deepa Nair,
  • Sudhir Nair,
  • Poonam Joshi,
  • Rathan Shetty

摘要

A rare but serious complication of neck dissections is chyle leak (CL), which can cause electrolyte disturbances, protein loss, local infection and rarely sepsis and mortality. There is lack of consensus to choose among the various management strategies. In this study, we report our experience at a tertiary cancer center in managing CL and propose an algorithm for its management. This is a retrospective review of a prospectively maintained surgical morbidity database, between 2015 to 2020. We analysed 8499 lateral cervical neck dissections involving level IV neck dissections. We studied the incidence, risk factors, clinical course of post-operative CL, and also the outcomes of conventional vs surgical management. The overall incidence of chyle leak in our institution was 2.65% (n-223), of which 83.4% was left-sided. 62.8% cases occurred in patients requiring therapeutic neck dissection (cN +). Of the entire cohort, (85.7%) had low output leaks, 91% were managed conservatively. Median duration of hospitalization for the entire cohort was 11 days. 20 cases required surgical exploration (8.96%), of these 18 (90%) were high output CLs. The amount of the daily drain output (high vs low) was significant in predicting the need for surgical exploration. Most patients with low output (< 500 ml) CL respond to conservative management with fat free diet and Medium chain triglycerides (MCT). Patients with high output CLs may benefit from early surgical or interventional management, reducing duration of inpatient stay and preventing its sequelae. Utility of other non-surgical and interventional management modalities, and their comparison with conservative measures, needs to be further studied.