Prospective identification of chyle leakage in patients undergoing lateral neck dissection for metastatic thyroid cancer

Background: Lateral neck dissection for metastatic thyroid cancer includes the lower jugular nodes, but there has been little study of chyle leakage. We therefore prospectively examined chyle leakage that occurred during and after lateral neck dissection in treatment of thyroid cancer. Methods: A total of 82 consecutive patients underwent 96 lateral neck dissections for metastatic differentiated thyroid cancer-42 in the right neck, 26 in the left neck, and 14 in both. All patients were monitored for intraoperative and postoperative chyle leakage. All postoperative drainage fluid and serum were chemically analyzed for triglycerides and cholesterol for early identification of chyle leakage. Results: Intraoperative chyle leakage was observed during 5 of the 96 neck dissections (5.2%), all on the left side and all controlled by suturing chyle fistula, thus avoiding postoperative leakage. Postoperative chyle leakage was observed in 8 of the 96 neck dissections (8.3%), 5 in the right and 3 in the left neck. The mean peak triglyceride concentration of drainage fluid was significantly higher in patients with chyle leakage than in those without (309 vs 42 mg/dl, P < 0.001). To stop leakage, 2 patients underwent reoperations. Chyle leakage stopped within 5-62 days (mean 18 days) after surgery. Conclusions: Chyle leakage related to lateral neck dissection for thyroid cancer is uncommon but may occur more frequently than reported previously, even in the right neck. Our findings may guide thyroid surgeons in both careful neck dissection in at-risk areas and proper postoperative management.