Chyle leak, although rare (1% and 2.5%), is a well-documented complication following surgical dissection of the neck. Although the left side of the neck is the most common site, chyle fistulas have been reported in the right side of the neck as well because of the variability in the lymphatic system, with the possibility of a thoracic duct outlet on the right side. Prolongation of a chyle leak can lead to longer hospital stays, delayed healing and necrosis of skin flaps. In refractory cases, a return to the operating room is also required, causing a substantial increase in cost for the hospitalisation. Traditional treatments for a chyle leak of the neck involve diet modification, closed drainage and use of pressure dressings.
Octreotide has been documented for the treatment of chylothorax as an effective means to resolve fistulas but its role to control chyle leak after neck dissection is controversial.
Authors aimed to assess the effectiveness and safety of octreotide for prompt resolution of chyle leaks of the neck. A retrospective review of 12 patients who received octreotide for chylous fistula after neck dissection was performed at two tertiary care academic hospitals. Octreotide therapy was started in all patients after clinical detection of the chyle fistula. Dosing of octreotide ranged from 50 mcg subcutaneously twice daily to 150 mcg subcutaneously every six hours. The most common dosing in this study was 100 mcg subcutaneously every eight hours. The chyle fistula resolved without operative intervention in all of the patients, with decreased drain output beginning on the first day of octreotide therapy. The chyle fistula resolved after a mean of 5.5 (range two to 11) days. Complications were uncommon and octreotide therapy was well tolerated in all patients. Octreotide is synthetic analogue of somatostatin. It has many inhibitory functions on hormones, but its effects on closing chyle leaks derive from its ability to decrease absorption of triglycerides and inhibit splanchnic circulation and gastrointestinal motility. Octreotide’s advantage over somatostatin is that it does not require continuous intravenous infusion, but rather, use of subcutaneous injection can sustain long-lasting effects. However, given the small sample size, definitive conclusions and recommendations cannot be made to endorse routine use of octreotide in patients with chyle leak.
