CHYLOTHORAX AFTER MINIMALLY INVASIVE ESOPHAGECTOMY: A RARE COMPLICATION

Abstract

Chylothorax is a rare but serious complication following esophagectomy, which may lead to respiratory failure, nutritional disorders, and prolonged hospitalization if not promptly recognized and appropriately managed. We report the case of a 67-year-old male patient diagnosed with squamous cell carcinoma of the middle third of the esophagus (cT4N0M0), who underwent neoadjuvant chemoradiotherapy followed by minimally invasive thoracoabdominal esophagectomy. Postoperatively, the patient developed rapidly recurrent bilateral pleural effusions accompanied by respiratory failure and pneumonia. Conservative management was initiated, including repeated pleural drainage, total parenteral nutrition, and a medium-chain triglyceride-based diet administered via jejunal feeding. Due to respiratory compromise, magnetic resonance lymphangiography was initially deferred. Delayed lymphatic imaging subsequently identified thoracic duct leakage at the T4-T5 level with formation of a mediastinal chylous collection. The chylothorax became self-limited and did not require lymphatic intervention. The patient gradually improved and was discharged on postoperative day 58, despite a complicated postoperative course. This case highlights the importance of early recognition of chylothorax after esophagectomy, appropriate timing of lymphatic imaging, and careful consideration of conservative versus interventional management strategies to minimize complications and improve clinical outcomes.