Chylothorax after lobectomy is common, lacking reliable preventive measures.
Octreotide is widely used for treatment of chyle leakage, but its role in preventing
chylothorax has not been estimated. The aim of this study was to evaluate whether prophylactic
octreotide could reduce the incidence of postoperative
chylothorax.Patients who underwent lobectomy for
lung cancer from January 2016 to September 2018 were retrospectively reviewed. The cases in prophylactic group received
octreotide 1 day before the surgery until removal of
chest tubes, while those in the control group did not use it unless the diagnosis of
chylothorax.A total of 379 patients were enrolled, with 190 patients in control and 189 cases in prophylactic group.
Octreotide was well tolerated in patients who received this agent. No 30-day mortality was indicated. Seven cases in control (3.7%, 7/190) and 3 cases in prophylactic group (1.6%, 3/189) with
chylothorax were observed (P = .337). The patients in prophylactic group showed shorter duration of chest drainage ([3.6 ± 1.6] days vs [4.1 ± 2.0] days, P = .006) and reduced drainage volume ([441.8 ± 271.1] mL vs [638.7 ± 463.3] mL, P < .001). In addition, they showed similar stations and numbers of dissected lymph nodes, surgery-related complications, and postoperative
hospital stay. Besides, 11 (5.8%, 11/190) patients in control and 6 (3.2%, 6/189) cases in the prophylactic group were readmitted for
pleural effusion needing reinsertion of
chest tubes (P = .321). Moreover, multivariable logistic analysis showed that induction
therapy (odds ratio [OR] =12.03; 95% confidence interval [CI] 3.15-46.03, P < .001) was a risk factor, while high-volume experience of the surgeon (OR = 0.23; 95% CI 0.06-0.97, P = .045) was a preventive factor of surgery-related
chylothorax. Additionally, prophylactic
octreotide (OR = 0.18; 95% CI 0.11-0.28, P < .001) and perioperative
low-fat diet (OR = 0.46; 95% CI 0.29-0.73, P = .001) were negatively associated with the drainage volume of
pleural effusion. Furthermore, high-volume experience of the surgeon (OR = 6.03; 95% CI 1.30-27.85, P = .021) and induction
therapy (OR = 8.87; 95% CI 2.97-26.48, P < .001) were risk factors of
unplanned readmission.Prophylactic
octreotide does not reduce the incidence of postoperative
chylothorax or
unplanned readmission following anatomic lobectomy. The routine application of
octreotide should not be recommended. High-quality trials are required to validate these findings.