Guidelines for Complications of Cancer Treatment Vol VIII Part B

Rationale:LCTs, which constitute 70% of dietary fat, enter the bloodthrough chyle. MCTs on the other hand are directly absorbedfrom the intestine into the portal circulation. Hence, foodsrich in MCTs (e.g. coconut oil) need to be administered topatients with chyle leaks. Premade formulae containing MCTsare also available.Total Parenteral Nutrition- Can be considered in patients onmedical management experiencing significant weight loss.However, TPN is expensive and requires infrastructure andhas its attendant risks. It may therefore be better to stop medicalmanagement and surgically manage the chyle leak .Surgical management Re-exploration with identification of the leak andsuturing with non absorbable suture material. Patient maybe administered fat in the form of cream enterally (thruryle’s tube) 1-2 hours prior to surgery to help identifythe exact site of leak intraoperatively. Use of gelfoam or surgical may help in sealing the leak,however not routinely recommended. Muscle flaps (e.g. levator scapulae flap) have beendescribed by some to seal the area (LOE-5). If leak persists, thoracoscopic ligation of the thoracicduct may help (LOE-3).243