Incidence and risk factors investigation of chylous leakage following thoracic or lumbar vertebrectomy: a single‑center, retrospective analysis of 545 patients.

Abstract

Objective: Thoracic or lumbar vertebrectomy is a complex spinal surgical procedure associated with considerable invasiveness and a high incidence of complications, including the infrequent chylous leakage. This study seeks to document the incidence of chylous leakage following thoracic or lumbar vertebrectomy and to investigate the risk factors associated with this complication, thereby offering insights into its prevention and management.

Methods: A retrospective analysis was performed with patients who underwent thoracic or lumbar vertebrectomy at our institution between July 2016 and March 2024. The patients who developed postoperative chylous leakage were incorporated into the chylous leakage group, and its incidence rate was determined. A subset of patients who underwent thoracic or lumbar vertebrectomy during the same surgical month as the chylous leakage cases while did not develop this complication were selected as control group. Comparative analyses of demographic variables, including gender, age, and surgical excised segments, were conducted between the two groups. Additionally, perioperative data, such as operation duration, blood loss, length of hospital stay, clinical outcomes, and radiological follow-up, were evaluated. Statistical analyses, including chi-square tests, Fisher's exact test, and t-tests, were employed to investigate the risk factors associated with chylous leakage following thoracic or lumbar vertebrectomy.

Results: The study included a total of 545 patients who underwent thoracic or lumbar vertebrectomy, among whom 5 cases of chylous leakage were identified, corresponding to an incidence rate of 0.92%. The control group comprised 29 patients. No significant statistical differences were observed between the chylous leakage group and the control group regarding demographic characteristics. However, analysis of radiological and perioperative data indicated that the thickness of peri-lesion soft tissues was significantly greater in the chylous leakage group compared to the control group (16.58 ± 9.95 mm vs. 10.36 ± 5.19 mm, P = 0.04). Furthermore, the surgical excised segments were predominantly located between T10-L2, with a statistically significant difference compared to the control group (P = 0.039). Other parameters, including blood loss, transfusion volume, operation duration, surgical approach, and reconstruction methods, did not exhibit significant differences. One patient with chylous leakage developed a wound infection and received debridement with drainage. Other cases of chylous leakage were managed conservatively and resolved successfully.

Conclusion: Thoracic or lumbar vertebrectomy presents a risk of compromising the lymphatic system, potentially resulting in chylous leakage, especially in patients exhibiting over-thickened peri-lesion soft tissues or excised segments at the thoracolumbar region. Enhanced vigilance is warranted in these patients to mitigate the risk of postoperative chylous leakage.