Chan Hon Chui1*, Anselm Chi-Wai Lee2
1Surgery Centre for Children, Mount Elizabeth Medical Centre, Singapore
2Children’s Hematology and Cancer Centre, Mount Elizabeth Hospital, Singapore
Objective: Postoperative Chylous Fistula (CF) complicates neuroblastoma resection, extends hospitalization and delays adjuvant chemotherapy. We aimed to review our group of delayed-onset CF patients who underwent conservative treatment with tube drainage. Methods: A retrospective study was conducted from our centre’s neuroblastoma database. Patients who developed delayed-onset CF treated with tube drainage on or after POD 21 were included. Patients’ demographic and clinical data were analyzed. Results: Among 233 neuroblastoma resections performed over an 8-year period, 12 (5.2%) patients developed delayed-onset CF. They included stage 4 high-risk (n=11) and intermediate-risk (n=1) groups. They received 1-3 cycles of postoperative chemotherapy before CF was diagnosed. Percutaneous tube drainage of CF was performed on median POD 35 (21-126) that obtained mean of 1572 (600-4000) ml/day or 100 (27-186) ml/kg/day on day 1, followed by continuous drainage with conservative CF treatment, including medium-chain triglyceride diet, parenteral nutrition, octreotide and albumin infusion when indicated. Concurrent chemotherapy was administered in 8 patients based on neuroblastoma protocol without dose or schedule modification. Drainage tubes dwelled for median 33 (9-49) days, and CF resolved on median POD 66 (36-154) after neuroblastoma resection. Four patients with refractory CF also underwent successful surgical ligation. 5-year-EFS and OS for high-risk group were 70% and 90% respectively. Conclusion: Conservative treatment with tube drainage remains the first-line approach to postoperative CF. Concurrent chemotherapy may proceed without dose modification. Adequate adherence to chemotherapy protocol ensures comparable oncological outcome.
Chui CH, Chi-Wai Lee A. The Management of Delayed-Onset Chylous Fistula after Neuroblastoma Resection in Children. Clin Surg. 2022; 7: 3472..