Lymphatic Interventions for Chylothorax: A Systematic Review and Meta-Analysis

Purpose: To perform a systematic review and meta-analysis of published studies to evaluate the efficacy of lymphatic interventions for chylothorax. Materials and Methods: The MEDLINE, EMBASE, and Cochrane databases were searched for English-language studies until March 2017 that included patients with chylothorax treated with lymphangiography (LAG), thoracic duct embolization (TDE), or thoracic duct disruption (TDD). Exclusion criteria were as follows: a sample size of less than 10 patients, no extractable data, or data included in subsequent articles or duplicate reports. Results: The cases of 407 patients from 9 studies were evaluated. The pooled technical success rates of LAG and TDE were 94.2% (95% confidence interval [CI], 88.4%-97.2%; I-2 = 46.7%) and 63.1% (95% CI, 55.4%-70.2%; I-2 = 37.3%), respectively. The pooled clinical success rates of LAG, TDE, and TDD, on a per-protocol basis, were 56.6% (95% CI, 45.4%-67.2%; I-2=5.4%), 79.4% (95% CI, 64.8%-89.0%; I-2 = 68.1%), and 60.8% (95% CI, 49.4%-71.2%; I-2 = 0%), respectively. The pooled major complication rate of LAG and TDE was 1.9% (95% CI, 0.8%-4.3%: I-2 = 0%) and 2.4% (95% Cl, 0.9%-6.6%; I-2 = 26.4%), respectively. The pooled overall clinical success rate of lymphatic interventions, on an intention-to-treat basis, was 60.1% (95% Cl, 52.1%-67.7%; I-2 = 54.3%). Etiology of chylothorax was identified as a significant source of heterogeneity for the pooled clinical success rate of TDE and overall clinical success rate. Conclusions: Lymphatic interventions have a respectable efficacy for the treatment of chylothorax.