P1.043. Chylothorax After Esophagectomy for Esophageal Cancer: Incidence, Risk Factors, and Clinical Outcomes After Esophageal Resection. a Systematic Review and Meta-Analysis

Abstract

Benign Disease: Iatrogenic Esophageal Disease, Perforation and Postsurgical Complications Chylothorax is an uncommon but potentially life-threatening complication after esophagectomy. Reported rates and proposed risk factors vary considerably across surgical eras, operative approaches, and institutional practices. A systematic review was conducted according to PRISMA 2020 principles. MEDLINE via PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to 31 December 2025 for English-language studies reporting chylothorax after esophagectomy for esophageal cancer. Random-effects meta-analyses were performed for pooled incidence, selected risk factors, and comparative postoperative outcomes. Twelve retrospective cohort studies comprising 10,414 patients and 298 chylothoraces were included. The pooled incidence of chylothorax was 3.3% (95% confidence interval 2.4% to 4.5%; I2 86.6%). Transthoracic versus transhiatal resection was not associated with a significant difference in risk (odds ratio 0.66, 95% confidence interval 0.18 to 2.35), nor was crude exposure to neoadjuvant therapy (odds ratio 1.12, 95% confidence interval 0.72 to 1.76). Advanced stage showed a nonsignificant trend (odds ratio 1.46, 95% confidence interval 0.79 to 2.72). Thoracic duct resection was the most consistent predictor in adjusted analyses (pooled adjusted odds ratio 5.16, 95% confidence interval 2.30 to 11.60). Patients who developed chylothorax had lower body mass index overall (mean difference -2.16 kg/m2, 95% confidence interval -3.21 to -1.12), higher in-hospital mortality (odds ratio 3.82, 95% confidence interval 1.25 to 11.64), and longer hospital stay (mean difference 5.97 days, 95% confidence interval 0.52 to 11.42). Chylothorax complicates approximately 1 in 30 esophagectomies for cancer. The most consistently identified risk factor is thoracic duct resection, while lower body mass index also appears clinically relevant. Chylothorax is associated with worse short-term outcomes, supporting early recognition, aggressive nutritional and fluid management, and prompt escalation when high-output leakage persists.