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Improving the management of cervical chyle leak following neck dissection

Published online by Cambridge University Press:  06 October 2025

Charles Picton Open the ORCID record for Charles Picton [Opens in a new window] ,
Stavroula Mouratidou ,
Ali Al-lami ,
Iain Nixon ,
Jean-Pierre Jeannon ,
Aleix Rovira ,
Andrea Bille ,
Karen Harrison-Phipps  and
Ricard Simo
Charles Picton*
Affiliation:
Head and Neck Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Stavroula Mouratidou
Affiliation:
Head and Neck Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Ali Al-lami
Affiliation:
Head and Neck Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK Ear Nose and Throat department, East Kent hospitals NHS Trust, England UK
Iain Nixon
Affiliation:
Head and Neck Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK Ear Nose and Throat Department, NHS Lothian, Scotland, UK
Jean-Pierre Jeannon
Affiliation:
Head and Neck Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Aleix Rovira
Affiliation:
Head and Neck Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Andrea Bille
Affiliation:
Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Karen Harrison-Phipps
Affiliation:
Department of Thoracic Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Ricard Simo
Affiliation:
Head and Neck Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
*
Corresponding author: Charles Picton; Email: charlie.picton@nhs.net
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Abstract

Objectives

The aim of this study is to assess outcomes in managing post-operative chyle leaks, following neck dissection using a volume-based risk stratification algorithm.

Methods

A retrospective series (2010–2024) at a tertiary head and neck centre included all patients with chyle leaks after neck dissection for malignancy. Chyle leaks were stratified as low, medium or high volume and managed either medically or with planned intervention, video-assisted thoracoscopic surgery, thoracic duct ligation or thoracic duct embolisation.

Results

Thirty-five patients were identified. Sixty-five point seven per cent (n = 23) with low-volume leaks resolved with conservative management, 31.4 per cent (n = 11) with moderate-/high-volume leaks underwent video-assisted thoracic duct ligation, with 10/11 resolving within one day post-operatively, 5.7 per cent (n = 2) underwent thoracic duct embolisation. All cases with ongoing chyle leaks resolved without neck re-exploration surgery.

Conclusion

Volume-based risk stratification, paired with early video-assisted thoracoscopic surgery ligation or embolisation, provides a highly effective, low-morbidity strategy for managing post-operative chyle leaks.

Keywords

Neck dissectionNeoplasmsTreatment outcomeEvidence-based medicinePathology

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 140 , Issue 1 , January 2026 , pp. 25 - 30
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

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