# Early Thoracic Duct Ligation for Post-esophagectomy Chyle Leak: A 10-Year Institutional Experience With Early Operative Intervention

## TL;DR

This study shows that early surgery to treat chyle leaks after esophagectomy is safer and more effective than conservative treatment.

## Contribution

The study provides evidence supporting early thoracic duct ligation as a novel treatment strategy for high-output chyle leaks.

## Key findings

- Early surgical ligation resolved all cases with no mortality, compared to 100% mortality with conservative therapy.
- Patients treated surgically had shorter hospital stays than those receiving conservative treatment.
- Chyle leak patients were significantly younger than those without leaks.

## Abstract

Background and aim

Chyle leak is a rare but potentially lethal complication following esophagectomy. Optimal timing for thoracic duct ligation remains unclear, particularly for high-output leaks. This study aimed to evaluate outcomes of early thoracic duct ligation compared with conservative therapy in post-esophagectomy chyle leak.

Methods

This is a retrospective study of 500 patients undergoing esophagectomy from 2016 to 2025 at a tertiary cancer center. Six patients (1.2%) developed chyle leak. Diagnosis was based on high-volume drainage, milky effluent after feeding, and biochemical confirmation. Conservative treatment included drainage, nil per oral, and total parenteral nutrition. Early thoracic duct ligation was performed via a transthoracic or transabdominal approach. Statistical tests included the t-test and Fisher’s exact test.

Results

Patients with chyle leak were significantly younger than those without leak (44.0±5.7 vs. 53.2±13.4 years; p=0.009). Conservative therapy (n=1) resulted in persistent leak and death (100% mortality). Early surgical ligation (n=5) achieved 100% resolution with no mortality and shorter hospital stay (13-14 days vs. 18 days). Overall mortality in the chyle-leak group was 16.7%, exclusively in the conservatively treated patient.

Conclusion

Early thoracic duct ligation appears to be a safe and effective strategy in selected high-output post-esophagectomy chyle leaks in our institutional experience. Prolonged conservative therapy in high-output leaks is associated with avoidable morbidity and mortality.