Abstract
BACKGROUND: Chyle leakage, a rare but serious complication of neck lymph node dissection, occurs in 2-8% of cases and can lead to severe outcomes such as electrolyte imbalances and infection. The 2022 Chinese expert consensus on the prevention and treatment of chyle leakage after neck dissection for thyroid cancer aimed to standardize management. This study evaluated the consensus's impact on chyle leakage incidence and management in patients undergoing lateral neck lymph node dissection for papillary thyroid carcinoma (PTC). METHODS: This retrospective study analyzed 360 patients who underwent lateral neck lymph node dissection for PTC between May 2020 and December 2023. Patients were divided into pre-consensus (n=231) and post-consensus (n=129) groups. The post-consensus group received standardized preventive measures, including meticulous ligation, local adhesives, and intraoperative techniques. Data on baseline characteristics, chyle leakage incidence, and treatment outcomes were compared. Statistical analyses were performed using SPSS version 27, with a P value <0.05 considered significant. RESULTS: The overall chyle leakage rate was 4.8% (20/399 dissections), with a significant reduction in the post-consensus group (1.6% vs. 7.8%, P=0.01). Left-sided dissections were associated with a higher incidence of chyle leakage (80.0% vs. 20.0%, P=0.01). Conservative management, including continuous drainage, local compression, and fat-free diets, was successful in 80% of cases. Surgical intervention was required in 4 cases, all from the pre-consensus group. The use of local adhesives, introduced post-consensus, demonstrated efficacy in reducing drainage volume. CONCLUSIONS: The implementation of the Chinese expert consensus significantly reduced the incidence of chyle leakage in patients undergoing lateral neck lymph node dissection for PTC. Systematic prevention and management strategies, including standardized surgical techniques and conservative treatments, are crucial in minimizing this complication. Further multicenter prospective studies are warranted to validate these findings and refine consensus recommendations.