Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical Nutrition

Nutritional management in patients with chyle leakage: a systematic review

Abstract

Background/Objectives:

To investigate all the available evidence assessing the effect of nutrition intervention on patients with chyle leakage and its effectiveness at reducing the need for surgical intervention.

Subjects/Methods:

A systematic review was undertaken of all English language studies using MEDLINE, Cinahl and Web of Science from January 1980 to September 2013. Case series were included because of limited available evidence. Exclusion criteria included animal studies, pediatrics and studies without nutritional intervention. Assessment of study quality was included. Because of the heterogeneity of the data, no meta-analysis was performed.

Results:

Thirty-one articles were identified for analysis, all of which were retrospective case series studies. The data within these studies were greatly limited. A total of 550 subjects were identified from these studies, 72% of whom had a chyle leak successfully resolved without surgical intervention. However, there was no significant difference between the type of dietary intervention and the rate of resolution (χ2=11.14, P=0.08).

Conclusions:

Although there is evidence to suggest that nutrition may have a role in the management of patients with chyle leakage, it is not possible to determine which dietary methods are most effective. More research is required before any guidelines for best practice can be established.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Nadolski GJ, Itkin M . Thoracic duct embolization for nontraumatic chylous effusion: experience in 34 patients. Chest 2013; 143: 158–163.

    Article  PubMed  Google Scholar 

  2. van der Gaag NA, Verhaar AC, Haverkort EB, Busch OR, van Gulik TM, Gouma DJ . Chylous ascites after pancreaticoduodenectomy: introduction of a grading system. J Am Coll Surg 2008; 207: 751–757.

    Article  PubMed  Google Scholar 

  3. Roh JL, Yoon YH, Park CI . Chyle leakage in patients undergoing thyroidectomy plus central neck dissection for differentiated papillary thyroid carcinoma. Ann Surg Oncol 2008; 15: 2576–2580.

    Article  PubMed  Google Scholar 

  4. Chalret du Rieu M, Mabrut JY . Management of postoperative chylothorax. J Visc Surg 2011; 148: e346–e352.

    Article  CAS  PubMed  Google Scholar 

  5. Lee H, Gumpeni R, Jain M, Talwar A . Chylothorax: a review of current management strategies: sequelae may include malnutrition and respiratory failure. OJRD 2008; 29: 325.

    Google Scholar 

  6. Smoke A, DeLegge MH . Chyle Leaks: consensus on management? Nutr Clin Pract 2008; 23: 529–532.

    Article  PubMed  Google Scholar 

  7. Townshend AP, Speake W, Brooks A . Chylothorax. EMJ 2007; 24: e11.

    Article  PubMed  Google Scholar 

  8. Havas T, Gullane P, Kassel R . The Incidence and management of chylous fistulae. Aust N Z J Surg 1987; 57: 851–854.

    Article  CAS  PubMed  Google Scholar 

  9. Braga M, Ljungqvist O, Soeters P, Fearon K, Weimann A, Bozzetti F . ESPEN Guidelines on Parenteral Nutrition: Surgery. Clin Nutr 2009; 28: 378–386.

    Article  CAS  PubMed  Google Scholar 

  10. Suddaby EC, Schiller S . Management of chylothorax in children. Pediatr Nurs 2004; 30: 290–297.

    PubMed  Google Scholar 

  11. Vogt EAM, Brody R . Nutritional management of chyle leaks. Support Line 2009; 31: 3–8.

    Google Scholar 

  12. Celona-Jacobs N, Lipson DA, Unger LD, Tino G . Improvement of chronic chylous pleural effusion using a restricted fat diet and medium chain triglycerides in a patient with congenital lymphangiectasia. Nutr Clin Pract 2000; 15: 127–129.

    Article  Google Scholar 

  13. Shimizu K, Yoshida J, Nishimura M, Takamochi K, Nakahara R, Nagai K . Treatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer. J Thorac Cardiovasc Surg 2002; 124: 499–502.

    Article  PubMed  Google Scholar 

  14. Takuwa T, Yoshida J, Ono S, Hishida T, Nishimura M, Aokage K et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg 2013; 146: 571–574.

    Article  PubMed  Google Scholar 

  15. Szabados E, Toth K, Mezosi E . Use of octreotide in the treatment of chylopericardium. Heart Lung 2011; 40: 574–575.

    Article  PubMed  Google Scholar 

  16. Aerts J, Matas A, Sutherland D, Kandaswamy R . Chylous ascites requiring surgical intervention after donor nephrectomy: case series and single center experience. Am J Transplant 2010; 10: 124–128.

    Article  CAS  PubMed  Google Scholar 

  17. Heyland DK, MacDonald S, Keefe L, Drover JW . Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA 1998; 280: 2013–2019.

    Article  CAS  PubMed  Google Scholar 

  18. de Gier HH, Balm AJ, Bruning PF, Gregor RT, Hilgers FJ . Systematic approach to the treatment of chylous leakage after neck dissection. Head Neck 1996; 18: 347–351.

    Article  CAS  PubMed  Google Scholar 

  19. Evans JG, Spiess PE, Kamat AM, Wood CG, Hernandez M, Pettaway CA et al. Chylous ascites after post-chemotherapy retroperitoneal lymph node dissection: review of the m. d. anderson experience. J Urol 2006; 176: 1463–1467.

    Article  PubMed  Google Scholar 

  20. Kaas R, Rustman LD, Zoetmulder FAN . Chylous ascites after oncological abdominal surgery: incidence and treatment. Eur J Surg Oncol 2001; 27: 187–189.

    Article  CAS  PubMed  Google Scholar 

  21. Nussenbaum B, Liu JH, Sinard RJ . Systematic management of chyle fistula: the Southwestern experience and review of the literature. Otolaryngol Head Neck Surg 2000; 122: 31–38.

    Article  CAS  PubMed  Google Scholar 

  22. Roh JL, Kim DH, Park CI . Prospective identification of chyle leakage in patients undergoing lateral neck dissection for metastatic thyroid cancer. Ann Surg Oncol 2008; 15: 424–429.

    Article  PubMed  Google Scholar 

  23. Worthington MG, de Groot M, Gunning AJ, von Oppell UO . Isolated thoracic duct injury after penetrating chest trauma. Ann Thorac Surg 1995; 60: 272–274.

    Article  CAS  PubMed  Google Scholar 

  24. Barendregt K, Soeters PB, Allison SP, Kondrup J . Basic concepts in nutrition: Diagnosis of malnutrition – Screening and assessment. e-SPEN 2008; 3: e121–e125.

    Article  Google Scholar 

  25. Assumpcao L, Cameron JL, Wolfgang CL, Edil B, Choti MA, Herman JM et al. Incidence and management of chyle leaks following pancreatic resection: a high volume single-center institutional experience. J Gastrointest Surg 2008; 12: 1915–1923.

    Article  PubMed  Google Scholar 

  26. Bolger C, Walsh TN, Tanner WA, Keeling P, Hennessy TP . Chylothorax after oesophagectomy. Br J Surg 1991; 78: 587–588.

    Article  CAS  PubMed  Google Scholar 

  27. Capocasale E, Iaria M, Vistoli F, Signori S, Mazzoni MP, Dalla Valle R et al. Incidence, diagnosis, and treatment of chylous leakage after laparoscopic live donor nephrectomy. Transplantation 2012; 93: 82–86.

    Article  PubMed  Google Scholar 

  28. Fahimi H, Casselman FP, Mariani MA, van Boven WJ, Knaepen PJ, van Swieten HA . Current management of postoperative chylothorax. Ann Thorac Surg 2001; 71: 448–450.

    Article  CAS  PubMed  Google Scholar 

  29. Lagarde SM, Omloo JM, de Jong K, Busch OR, Obertop H, van Lanschot JJ . Incidence and management of chyle leakage after esophagectomy. Ann Thorac Surg 2005; 80: 449–454.

    Article  PubMed  Google Scholar 

  30. Le Pimpec-Barthes F, D'Attellis N, Dujon A, Legman P, Riquet M . Chylothorax complicating pulmonary resection. Ann Thorac Surg 2002; 73: 1714–1719.

    Article  PubMed  Google Scholar 

  31. Seow C, Murray L, McKee RF . Surgical pathology is a predictor of outcome in post-operative lymph leakage. Int J Surg 2010; 8: 636–638.

    Article  PubMed  Google Scholar 

  32. Walshe C, Bourke J, Lynch M, McGovern M, Delaney L, Phelan D . Culture positivity of CVC's used for TPN: Investigation of an association with catherter-related infection and comparison of causative organisms between ICU and non-ICU CVC's. J Nutr Metab 2012; 2012: 257959.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Merigliano S, Molena D, Ruol A, Zaninotto G, Cagol M, Scappin S et al. Chylothorax complicating esophagectomy for cancer: a plea for early thoracic duct ligation. J Thorac Cardiovasc Surg 2000; 119: 453–457.

    Article  CAS  PubMed  Google Scholar 

  34. Allaham AH, Estrera AL, Miller CC 3rd, Achouh P, Safi HJ . Chylothorax complicating repairs of the descending and thoracoabdominal aorta. Chest 2006; 130: 1138–1142.

    Article  PubMed  Google Scholar 

  35. Bonavina L, Saino G, Bona D, Abraham M, Peracchia A . Thoracoscopic management of chylothorax complicating esophagectomy. J Laparoendosc Adv Surg Tech A 2001; 11: 367–369.

    Article  CAS  PubMed  Google Scholar 

  36. Malik HZ, Crozier J, Murray L, Carter R . Chyle leakage and early enteral feeding following pancreatico-duodenectomy: management options. Dig Surg 2007; 24: 418–422.

    Article  CAS  PubMed  Google Scholar 

  37. Tulunay G, Ureyen I, Turan T, Karalok A, Kavak D, Ozgul N et al. Chylous ascites: analysis of 24 patients. Gynecol Oncol 2012; 127: 191–197.

    Article  PubMed  Google Scholar 

  38. Barker LA, Gray C, Wilson L, Thomson BNJ, Shedda S, Crowe TC . Preoperative immunonutrition and its effect on postoperative outcomes in well-nourished and malnourished gastrointestinal surgery patients: a randomised controlled trial. Eur J Clin Nutr 2013; 67: 802–807.

    Article  CAS  PubMed  Google Scholar 

  39. Alexiou C, Watson M, Beggs D, Salama FD, Morgan WE . Chylothorax following oesophagogastrectomy for malignant disease. Eur J Cardiothorac Surg 1998; 14: 460–466.

    Article  CAS  PubMed  Google Scholar 

  40. Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC . Postoperative chylothorax. J Thorac Cardiovasc Surg 1996; 112: 1361–1365.

    Article  CAS  PubMed  Google Scholar 

  41. Dugue L, Sauvanet A, Farges O, Goharin A, Le Mee J, Belghiti J . Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy. Br J Surg 1998; 85: 1147–1149.

    Article  CAS  PubMed  Google Scholar 

  42. Izzard ME, Crowder VL, Southwell KE . The use of Monogen in the conservative management of chylous fistula. Otolaryngol Head Neck Surg 2007; 136: S50–S53.

    Article  PubMed  Google Scholar 

  43. Nishigori H, Ito M, Nishizawa Y, Koyama A, Koda T, Nakajima K et al. Postoperative chylous ascites after colorectal cancer surgery. Surg Today 2012; 42: 724–728.

    Article  PubMed  Google Scholar 

  44. Shah RD, Luketich JD, Schuchert MJ, Christie NA, Pennathur A, Landreneau RJ et al. Postesophagectomy chylothorax: incidence, risk factors, and outcomes. Ann Thorac Surg 2012; 93: 897–903.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Singh M, Deo SV, Shukla NK, Pandit A . Chylous fistula after axillary lymph node dissection: incidence, management, and possible cause. Clin Breast Cancer 2011; 11: 320–324.

    Article  PubMed  Google Scholar 

  46. Spiro JD, Spiro RH, Strong EW . The management of chyle fistula. Laryngoscope 1990; 100: 771–774.

    Article  CAS  PubMed  Google Scholar 

  47. Zhou W, Liu Y, Zha X, Zheng W, Chen L, Xie X et al. Management of chylous leakage after breast surgery: report of four cases. Surg Today 2011; 41: 1639–1643.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S Carey.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Author Contributions

All authors have contributed to the paper. BRS refined the methodology, conducted the systematic review, analyzed the results and drafted the manuscript. CS designed the research, refined the systematic review, reviewed the results and was involved in the manuscript preparation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Steven, B., Carey, S. Nutritional management in patients with chyle leakage: a systematic review. Eur J Clin Nutr 69, 776–780 (2015). https://doi.org/10.1038/ejcn.2015.48

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2015.48

This article is cited by

Search

Quick links