Clinical outcomes of chyle fistula management post-thyroidectomy with neck dissection: A prospective study

Abstract

Background: Chyle fistula is a rare but potentially serious complication following neck dissection for thyroid cancer, associated with metabolic disturbances and delayed recovery. Optimizing its management remains a clinical challenge due to the lack of consensus on treatment strategies. The study aimed to evaluate the effectiveness of several improvements in the management of chyle fistula in patients undergoing neck dissection during thyroid cancer surgery. Methods: A prospective cross-sectional study was conducted on 32 patients who developed chyle fistula during or after thyroidectomy with neck dissection at Viet Tiep Friendship Hospital between March 2023 and March 2024. Intraoperative chyle leaks were managed by direct ligation with 5-0 Prolene sutures. Postoperative leaks were initially treated with conservative measures including total parenteral nutrition, targeted cervical compression, and low-pressure drainage. Surgical intervention was reserved for cases unresponsive to conservative therapy. Patients were followed clinically and sonographically for three months postoperatively. Results: Chyle fistula was detected intraoperatively in 16 patients (50%) and postoperatively in 16 patients (50%). Successful intraoperative closure was achieved in 81.2% of cases. Conservative management was successful in 94.7% of patients, with only one patient (5.3%) requiring surgical repair. The mean duration of drainage was 7 ± 2.8 days. At three months, 96.9% of patients exhibited normal wound healing without residual fluid collections, and only one patient reported mild sensory disturbance. Conclusion: Chyle fistula following neck dissection for thyroid cancer can be effectively managed with early intraoperative ligation and structured conservative therapy. High success rates and favorable functional outcomes can be achieved with an individualized, stepwise approach.