Seattle Surgical Society Meeting February 5, 2016

Slides:

Advertisements

Similar presentations

23/9/10. A 50 years old male was transferred from other hospital. One day before referal, he was admitted to that hospital because of severe epigastric.

Advertisements

Carcinoma of the Cardia: Is there progress in the management of non-Barrett’s cancer Spanish Association of Surgeons Madrid 11 November 2002 The University.

These are actual cases to –Stimulate your reading –Test your knowledge of the material Look for the sound icon (often in the upper right hand corner.

« A Clear cell sarcoma » FN. 25 year-old male January cm mass on the medial side of the right heel Early August cm clinical right.

By Preston Paynter and Brielle Bowyer. Reasons for Procedure  Pancreatic Cancer  Chronic Pancreatitis  Severe trauma to the Pancreas.

Management Algorithm for Aortoesophageal Fistulas  Joseph D Whitlark MD FACS, Lydia Rotondo DNP RN, Alex Su  THORACIC AND VASCULAR ASSOCIATES OF KINSTON,

Matthew Kilmurry, M.D. St. Mary’s General Hospital Grand River Hospital.

Nurse Navigators and the Cancer Institute Yousuf A. Gaffar, MD Hematology / Medical Oncology The Cancer Institute University of Maryland St. Joseph Medical.

Thoracic Surgery By Mike Poullis.

Post-treatment management of esophageal cancers: Surgical considerations Stephen Swisher, MD PhD Robert F. Fly Professor of Surgical Oncology Chairman,

ESOPHAGEAL RESECTION DR V JONKER Dept cardiothoracic Surgery Yunivesithi Ya Freistata.

T4 Colon Cancer and Laparoscopic Approach Gustavo Plasencia MD FACS, FASCRS Clinical Professor of Surgery Gustavo Plasencia MD FACS, FASCRS Clinical Professor.

Moderators: David Cort, MD Alex Denes, MD Panelists: Stephen Swisher, MD, PhD Edward Lin, MD.

Management of Postoperative Pleural Effusions AATS 2015 Allied Health Personnel Symposium Seattle, April Eric Vallières MD FRCSC Swedish Cancer.

Minimally Invasive Esophagectomy Dmitry Oleynikov M.D. Associate Professor of Surgery Joseph and Richard Still Faculty Fellow in Medicine Director of Minimally.

Thoracic Surgery 8/24/14– 8/30/14 Poornima Vanguri.

Thoracic Surgery 08/10/14 – 08/16/14 Christine Zoon.

Esophageal Cancer J. Timothy Sherwood MD Thoracic Surgeon

Case report Ovarian cancer Ami Fishman, M.D. Meir Hospital - Sapir Med Center Kfar-Saba, Israel Ovarian cancer Ami Fishman, M.D. Meir Hospital.

Duodenum preserving pancreatic head resection

Differential Response to Preoperative Chemoradiation and Surgery in Esophageal Adenocarcinomas Based on Presence of Barrett's Esophagus and Symptomatic.

Fig year-old man with history of esophageal cancer; status post total esophagectomy who presented with average of 2-3 L of left chylous effusion.

Comparison of Conventional and Wire Mesh Expandable Prostheses and Surgical Bypass in Patients With Malignant Esophagorespiratory Fistulas Donald E.

Thoracic Surgery On-Line

Department of General Surgery, Upper Gastrointestinal Unit,

Esophagogastric Metaplasia Relates to Nodal Metastases in Adenocarcinoma of Esophagus and Cardia Alberto Ruffato, MD, PhD, Sandro Mattioli, MD, Ottorino.

Evaluation of Minimally Invasive Approaches to Achalasia in Children

Morbidity and Mortality Conference

By: GARGI PINGALE and SAHANA KOUNDINYA

Major bile duct injury after open cholecystectomy

Complications of abdominal surgery

Gastric stump adenocarcinoma

Resection and Mediastinal Lymph Node Dissection

A comparison between 3D & conventional laparoscopic colectomy

Ninh T. Nguyen, MD, Cam-Ly Tran, MD, Dmitri V

Esophageal Diversion Daniel P. Raymond, MD, Thomas J. Watson, MD

Esophagectomy Combined With Aortic Segment Replacement for Esophageal Cancer Invading the Aorta Zhuangzhuang Cong, MD, Qiang Diao, MD, Jun Yi, MD, PhD,

Adenocarcinoma in a 40-Year-Old Colonic Interposition Treated With Ivor Lewis Esophagectomy and Esophagogastric Anastomosis David D. Shersher, MD, Edward.

Esophageal Stent Placement for the Treatment of Acute Intrathoracic Anastomotic Leak After Esophagectomy Richard K. Freeman, MD, Amy Vyverberg, RN, Anthony.

Robert J Cerfolio, MD, Cyndi Bass, MSN, Charles R Katholi, PhD

Robert A. Meguid, MD, MPH, FACS

Radical En Bloc Esophagectomy for Carcinoma of the Esophagus

Esophagectomy Combined With Aortic Segment Replacement for Esophageal Cancer Invading the Aorta Zhuangzhuang Cong, MD, Qiang Diao, MD, Jun Yi, MD, PhD,

Review on Management of Gastro-esophageal Junction Cancer

Esophagectomy Outcomes in the Endoscopic Mucosal Resection Era

Chylothorax Complicating Pulmonary Resection for Lung Cancer: Effective Management and Pleurodesis Hyun Jin Cho, MD, Dong Kwan Kim, MD, Geun Dong Lee,

The Incidence and Management of Postoperative Chylothorax After Pulmonary Resection and Thoracic Mediastinal Lymph Node Dissection Ayesha S. Bryant,

Jejunal Interposition for Esophageal Replacement

Esophageal Ultrasound-Controlled Fine Needle Aspiration for Staging of Mediastinal Lymph Nodes in Patients with Resectable Lung Cancer: Do We Always See.

Clinical responses in patients.

Selective En Masse Ligation of the Thoracic Duct to Prevent Chyle Leak After Esophagectomy Yidan Lin, MD, Zhihui Li, MD, Gang Li, MD, Xiaolong Zhang,

Serial Drain Amylase Can Accurately Detect Anastomotic Leak After Esophagectomy and May Facilitate Early Discharge Yaron Perry, MD, Christopher W. Towe,

Treatment of Postsurgical Chylothorax

Aortic stent-grafting facilitates a successful resection after neoadjuvant treatment of a cT4 esophageal cancer Tomoki Makino, MD, Takushi Yasuda, MD,

Transmanubrial Osteomuscular Sparing Approach for Apical Chest Tumors

Survival After Surgical Resection of Stage IV Esophageal Cancer

James R. Fenton, MD, Edward J

Daniel L. Miller, MD, Gerald A. Helms, MD, William R. Mayfield, MD

Pursestring Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy Ren-Quan Zhang, MD, Wan-Li Xia, MD, Ning-Ning Kang, MD, Wei.

Staged Repair of Benign Tracheo-Neo-Esophageal Fistula 12 Years After Esophagectomy for Esophageal Cancer Charles Bakhos, MD, MS, Saleh Alazemi, MD,

Daily Chest Roentgenograms Are Unnecessary in Nonhypoxic Patients Who Have Undergone Pulmonary Resection by Thoracotomy Robert James Cerfolio, MD, Ayesha.

Pathologic complete response after esophagectomy following neoadjuvant chemoradiation therapy for esophageal carcinoma: A cure sometimes? Shawn S. Groth,

Pulmonary nodules discovered on CT scan of the chest

Postoperative Pleural Effusion in Bronchioloalveolar Cancer

Comparison of Conventional and Wire Mesh Expandable Prostheses and Surgical Bypass in Patients With Malignant Esophagorespiratory Fistulas Donald E.

Robert James Cerfolio, MD, FACS, FCCP, Ayesha S. Bryant, MSPH, MD

Is There a Benefit to Prolonging the Interval Between Neoadjuvant Chemoradiation and Esophagectomy in Esophageal Cancer? Anna Lee, MD, MPH, Andrew T.

The Removal of Chest Tubes Despite an Air Leak or a Pneumothorax

Esophagogastric Metaplasia Relates to Nodal Metastases in Adenocarcinoma of Esophagus and Cardia Alberto Ruffato, MD, PhD, Sandro Mattioli, MD, Ottorino.

Patterns-of-Care for Thoracic Stereotactic Body Radiotherapy among Practicing Radiation Oncologists in the United States Megan E. Daly, MD, Julian R.

Presentation transcript:

Post-Esophagectomy Chyle Leak: How to Make a Complex Problem Really Interesting! Seattle Surgical Society Meeting February 5, 2016 Mustapha A. El Lakis, MD Kirsten Newhams, MD, MPH Donald E. Low, FACS FRCS(C) Thoracic Surgery and Thoracic Oncology Virginia Mason Medical Center

Post-Esophagectomy Chyle Leak: How to Make a Complex Problem Really Interesting! Patient Background 66 Y.O. female BMI 44 Long history GERD and Barrett’s esophagus Follow up EGD  Distal esophagus tumor Bx – moderately diff adenocarcinoma CT, PET, EDGUS  cT2N1Mx Treatment Neoadjuvant chemoradiation Restaging Residual tumor 31-36 cm Barrett’s 26-36 cm Surgery #1 Left thoracoabdominal resection with cervical esophagogastrostomy Feeding jejunostomy ICU 1 day Final path No residual esophageal cancer 1 of 33 lymph nodes positive pT0N1

Post-Esophagectomy Progress POD 4-8 Output left chest drain 1.2-1.5 L/day POD 9 Surgery #2 Limited right thoracotomy Mass ligation thoracic duct at hiatus POD 10 Chest drains clamped Continue TPN POD 1 Initiate J-tube feeds POD 2 Output left chest drain 400 cc  1 L/24 hr J-tube feeds held POD 3 Start TPN Chest drain output 1.3 L Triglycerides mod elevated UGI no leak good emptying

POD 11-18 POD 19 POD 20-21 POD 22 Patient stable off O2 POD 6 2nd op pneumo loc fluid IR CT RX pneumo loculated fluid POD 11-18 Patient stable off O2 POD 19 Increasing SOB and O2 requirements CXR left apical pneumothorax and loculated left effusion IR guided chest drain into left pneumothorax POD 20-21 Output from left apical chest drain 4-5 L/day Triglycerides just above normal POD 22 Lymphangiograph

Lymph 11 days following OP 2 lymph thor duct clip Lymph 11 days following OP 2

Post-Esophagectomy Chyle Leak POD23 Surgery #3 150 cc cream through J-tube starting 2 hours before incision Laparotomy Mobilization of gastric conduit Over sewing of cisterna chyli leak POD24 Output from left chest drain 40cc POD 32 Patient discharged Low fat oral diet MCT J-tube feeds Occurs in 1 - 9% of patients following esophageal resection Chyle leaks originating in the abdomen and draining exclusively into the chest following esophagectomy is rare but surgeons should be aware of this unusual presentation