Efficacy and predictor of octreotide treatment for postoperative chylothorax after thoracic esophagectomy.

BACKGROUND: Postoperative chylothorax sometimes follows thoracic esophagectomy for esophageal cancer. The effectiveness of octreotide treatment for it and factors that predict its response are unclear. This study aimed to evaluate the efficacy of octreotide for treating postoperative chylothorax following thoracic esophagectomy for esophageal cancer and factors that might predict successful treatment and allow chest drain removal.

METHODS: We assessed 521 consecutive patients who underwent thoracic esophagectomy for esophageal cancer to investigate the efficacy of octreotide for postoperative chylothorax. Among those with postoperative chylothorax, one group (group A) underwent conservative management, and the other (group B) was treated conservatively with added octreotide administration. We evaluated the clinical outcomes after octreotide administration and assessed the factors associated with successful treatment.

RESULTS: Among the 521 patients, 20 (3.8%) developed postoperative chylothorax: five in group A and 15 in group B. Two of the five (20%) group A patients and 13 of the 15 (86.6%) group B patients were treated successfully (p = 0.03). Factors significantly associated with treatment failure were (1) chest drain output of >1,000 ml/day before treatment (p = 0.04); (2) no reduction in chest drainage by the second day of treatment (p = 0.016); (3) chest drainage of >1,000 ml/day through the second day of treatment (p = 0.006).

CONCLUSIONS: For patients with esophageal cancer who undergo thoracic esophagectomy, octreotide can be an effective treatment for postoperative chylothorax.