A Novel Technique for Reducing the Occurrence of Chylous Fistula After Lateral Neck Lymph Node Dissection for Thyroid Carcinoma: Reverse-Sequence Dissection and Protection of the Thoracic Duct and Right Lymphatic Duct

Abstract

Background

Lateral neck lymph node dissection (LLND) for thyroid carcinoma can result in chylous fistula, a complication with limited preventative surgical techniques. This study aimed to evaluate the impact of a novel surgical technique, reverse-sequence dissection and protection of the thoracic duct or right lymphatic duct, in reducing chylous fistula incidence post-LLND.

Methods

This study included 989 patients who underwent LLND between October 2019 and February 2024. Patients were divided into two groups based on the surgical technique: Group A (reverse-sequence dissection and protection of the thoracic duct and/or right lymphatic duct; n = 494) and Group B (prophylactic ligation of tissue around the venous angle; n = 495). The primary outcome was postoperative chylous fistula incidence.

Results

The chylous fistula rate in group A (0.81%) was significantly lower compared to group B (5.05%, P = .0001). Group A had a significantly lower median peak output of 24-hour chylous fistula (32.50 [30.00, 36.25] ml/day vs 67.00 [55.00, 75.00] ml/day, P = .0188).

Conclusion

The reverse-sequence dissection technique, combined with protection of the thoracic duct and/or the right lymphatic duct, effectively reduces the occurrence of chylous fistula following LLND for thyroid carcinoma.