Success rates of conservative treatment and optimal surgical timing for pediatric chylothorax

Abstract

Background: Pediatric chylothorax poses management challenges, with conservative treatment as the firstline approach and surgery reserved for persistent cases. However, data remain limited on factors related to conservative treatment success and optimal surgical timing. Purpose: This study aimed to evaluate the success rate of conservative treatment, identify the associated factors, and determine the optimal timing for surgical intervention. Methods: We retrospectively reviewed pediatric chylothorax cases at Siriraj Hospital treated between January 2012 and December 2022. Clinical and laboratory parameters, treatment modalities, and outcomes were analyzed. Results: Thirty pediatric patients were included (median age, 1.7 months); 67% were male. Conservative treatment had an overall success rate of 83.3% (25 of 30) and a 95% (19 of 20) success rate among patients with chylothorax after congenital heart disease surgery. Among the factors associated with successful conservative treatment, chylothorax caused by surgery was associated with a significantly higher success rate than nonsurgical causes (91.7% vs. 50%, respectively; P=0.04). The successful group exhibited a significantly lower peak pleural fluid flow rate than the unsuccessful group (26.8 mL/kg/day vs. 91 mL/ kg/day, P=0.002). A time-to-event analysis showed that the success rate of conservative treatment for postsurgical chylothorax was 78% at 14 days, suggesting that 2 weeks may be the optimal timing for surgical intervention. Conclusion: Conservative treatment is an effective firstline treatment for pediatric chylothorax. The etiology and peak flow rate of pleural fluid drainage are associated with its success. Optimized surgical intervention timing is crucial for improving outcomes.