Journal of Clinical Medicine
Cervical Chylous Fistula After Lymphadenectomy for Differentiated Thyroid Carcinoma: Anatomy, Risk Factors, and Management Strategies—A Narrative Review
By Ovidiu Fabian, Emilia Maria Pătruţ, Flaviu Mureșan and 2 others.
Abstract
Background
Cervical chylous fistula is a rare but potentially severe complication of laterocervical lymphadenectomy associated with thyroidectomy for thyroid carcinoma with lateral lymph node metastases. It occurs predominantly during level IV dissection in the proximity of the jugulo-subclavian confluence. Injury to the thoracic duct or the right lymphatic duct can generate persistent lymphorrhagia, leading to severe electrolyte imbalances, hypoproteinemia, and lymphopenia. The anatomical variability of the terminal portion of the thoracic duct justifies a comprehensive analysis of prevention and management strategies.
Methods
A structured narrative analysis of data on thoracic duct anatomy, cervical compartment classifications, and therapeutic options was performed using a database search paired with citation tracking. Intraoperative identification techniques, ligation methods, and conservative and interventional strategies were critically evaluated.