Bilateral Chylothorax Following Neck Dissection: A Systematic Review and Proposed Management Algorithm

Salman Hussain; Jafar Hayat; Fatma Ibrahim; Abdulmuhsen Almutairi; Bedour Alhajri; Maha Al-Gilani

doi:10.1007/s12070-024-04688-7

Bilateral Chylothorax Following Neck Dissection: A Systematic Review and Proposed Management Algorithm

Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):4900-4909. doi: 10.1007/s12070-024-04688-7. Epub 2024 Jul 1.

Authors

Salman Hussain¹, Jafar Hayat², Fatma Ibrahim², Abdulmuhsen Almutairi³, Bedour Alhajri², Maha Al-Gilani¹

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, ON Canada.
² Department of Otolaryngology - Head and Neck Surgery, Jaber Alahmad Hospital, Kuwait City, Kuwait.
³ Department of General Surgery, Jaber Alahmad Hospital, Kuwait City, Kuwait.

PMID: 39376331
PMCID: PMC11455751 (available on 2025-10-01)
DOI: 10.1007/s12070-024-04688-7

Abstract

Aims: Bilateral chylothoraces are rare but potentially life-threatening complications of neck dissections (ND). The condition is generally treated with a combination of dietary, medical, procedural, and surgical approaches. The aim of this review is to highlight the management options currently utilized in clinical practice and propose a management algorithm for this condition.

Methods: In accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; utilizing the Pubmed, EMBASE, and Web of Science databases, a systematic review of all available literature on bilateral chylothoraces was conducted. Primary outcomes measures included clinical presentations and type of neck dissection performed with interventions employed to manage the condition. Secondary outcome measures included the time to resolution alongside patient outcomes.

Results: We identified 37 patients (female n = 27, male n = 10) who presented with bilateral chylothoraces within the years 1951-2018. The mean age was 51.4 ± 16.5 years within the age ranges of 17-78 years. Most common pathologies included papillary thyroid carcinoma (n = 16), squamous cell carcinoma (SCC) of the larynx (n = 3), supraglottic SCC (n = 3). Left sided ND was done in (n = 18); bilateral ND in (n = 17); central/left ND in (n = 2). Chylothorax was treated by surgery in n = 10, n = 5 of which performed lymph node embolization; and n = 5 used lymph node ligation. Resolution was found in all cases. Discharge times ranged from 2 to 40 days.

Conclusions: This systematic review highlights the different management modalities in treating bilateral chylothoraces alongside providing a decision algorithm in treating the condition by suggesting diagnostic tools and management modalities to optimize patient care.

Keywords: Bilateral chylothorax; Neck dissection; Octreotide; Surgical management; Thoracic duct.

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