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Chyle Leak After Axillary Node Clearance in Breast Cancer Surgery—A Rare Complication and a Proposed Management Strategy from the British and Italian Experience

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Chyle leak after axillary surgery is a rare complication that lacks consensus and management guidelines. This study aimed to present the experiences of two centers in chyle leak management after axillary node clearance for breast cancer. Furthermore the authors provide a review of its pathophysiology and clinical diagnostic methods. They compare approaches for management of the axilla with those for other locations.

Methods

A multicentre case series descriptive analysis of chyle leak after breast cancer axillary node clearance between 1 January 2013 and 31 May 2020 was performed.

Results

The center in the United Kingdom and the center in Italy performed 655 and 4969 axillary node clearances, respectively. Four patients experienced chyle leaks. All the leaks had left-sided surgery (3 patients had level 3 clearances with mastectomy and implant-based breast reconstructions; 1 patient had level 2 clearance with therapeutic mammoplasty). All the leaks appeared within 3 days after surgery. Leak duration was between 11 and 29 days. The maximum daily output was 600 mL. All the leaks were treated conservatively with nutritional team support together with close drainage monitoring. The management strategy included a low-fat diet, a high-protein diet, total parenteral nutrition, and medium chain triglyceride supplements, as well as other elements. No negative effects on oncoplastic and reconstructive breast surgery wound-healing and no delays in adjuvant treatment were observed.

Conclusion

The incidence of chyle leak after breast cancer axillary node clearance was 0.07%. Early diagnosis and close monitoring together with conservative management involving nutritional team support can result in successful treatment of chyle leak without negative sequalae of breast cancer oncologic treatment.

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Authors and Affiliations

  1. Breast Surgery Department, City Hospital Birmingham, Sandwell and West Birmingham NHS Trust, Birmingham, UK

    Arwa Ashoor MBBS, SBGS, MRBS, MCh Edin, Uttaran Datta MBBS, MSc & Melissa Ley-Hui Tan MBChB, MRCS, MEd DIC, FRCS

  2. Division of Breast Surgery, IEO, European Institute of Oncology, IRCCS, 20141, Milan, Italy

    Germana Lissidini MD, PhD, Lorenzo Bertoldi MD & Paolo Veronesi MD

  3. Department of Oncology and Hemato-Oncology, University of Milan, 20133, Milan, Italy

    Paolo Veronesi MD

Authors
  1. Arwa Ashoor MBBS, SBGS, MRBS, MCh Edin
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  2. Germana Lissidini MD, PhD
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  3. Uttaran Datta MBBS, MSc
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  4. Lorenzo Bertoldi MD
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  5. Paolo Veronesi MD
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  6. Melissa Ley-Hui Tan MBChB, MRCS, MEd DIC, FRCS
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Correspondence to Arwa Ashoor MBBS, SBGS, MRBS, MCh Edin.

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Ashoor, A., Lissidini, G., Datta, U. et al. Chyle Leak After Axillary Node Clearance in Breast Cancer Surgery—A Rare Complication and a Proposed Management Strategy from the British and Italian Experience. Ann Surg Oncol 29, 7992–7999 (2022). https://doi.org/10.1245/s10434-022-12094-y

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  • DOI: https://doi.org/10.1245/s10434-022-12094-y

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