Therapeutics and Clinical Risk Management (Feb 2025)
Chinese Expert Consensus on Preventing and Managing Chyle Fistula in Cervical Lymph Node Dissection for Thyroid Cancer (2024)
Abstract
Qingqing He,1 Wen Tian,2 Jingqiang Zhu,3 Ping Wang,4 Hao Zhang5 On behalf of the Expert Working Group on Thyroid Surgery, Chinese Medical Doctor Association Division of Surgeons, Thyroid Disease Committee of Chinese Research Hospital, Association and General Surgery Branch of China International Exchange and Promotive Association for Medical and Health Care1Department of Thyroid and Breast Surgery, the 960th Hospital of the PLA Joint Logistics Support Force, Jinan, Shandong Province, 250031, People’s Republic of China; 2Department of General Surgery, General Hospital of the People’s Liberation Army (PLA), Beijing, 100853, People’s Republic of China; 3Center of Thyroid & ParaThyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China; 4Department of General Surgery, Second Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, Zhejiang Province, 310009, People’s Republic of China; 5Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, 110001, People’s Republic of ChinaCorrespondence: Qingqing He, Email [email protected]; Wen Tian, Email [email protected]: The prevalence of thyroid carcinoma is on the rise, with cervical lymph node metastasis being a frequent occurrence necessitating surgical intervention. Chyle fistula, a significant postoperative complication, can have a substantial impact on recovery.Objective: To reduce the incidence of chyle fistula, enhance the effectiveness of postoperative treatment, and assist thyroid surgeons in performing cervical lymph node dissection, the consensus was compiled in a standardized and secure manner.Methods: Drawing from the expertise of Chinese specialists in managing chyle fistula and the latest international advancements in this field following cervical lymph node dissection, the thyroid tumor experts group of Chinese Thyroid Association, Chinese College of Surgeons, Chinese Medical Doctor Association and Thyroid Disease Professional Committee of Chinese Research Association have developed innovative approaches to address this issue. An evidence-based approach was employed, integrating the knowledge and practical experience of the panelists.Results: We developed twelve expert consensus recommendations, addressing the prevention, diagnosis, and treatment of postoperative chyle fistula. These recommendations included the dietary management and nutritional support, continuous negative pressure suction, local adhesive treatment, application of local compression methods, the use of somatostatin and its analogs, and surgery treatment.Conclusion: This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the management of chyle fistula.Keywords: thyroid carcinoma, Chyle fistula, expert consensus, cervical lymph node dissection, thoracic duct
