From the Guidelines
Pleural effusion after cervical lymphadenectomy is a common complication that typically does not require intervention, as most effusions do not impact morbidity or mortality. According to the European Respiratory Journal study 1, postoperative pleural effusions have varying aetiology and presentation depending on the primary diagnosis and surgery type, and management should be tailored accordingly.
Key Considerations
- The need for intervention should not be dictated by radiological features alone, as studies have shown that most effusions do not require intervention 1.
- A protocolised pathway for intervention may result in small improvements in walking distance and reduced lengths of hospital stay, but has no impact on quality of life or self-reported symptoms 1.
- Ultrasound-guided thoracocentesis is a safe and effective procedure for managing pleural effusions, and has largely replaced the need for more invasive surgical tube thoracostomy 1.
Management Approach
- For most cases, a conservative management approach with observation and chest tube drainage may be sufficient, as the effusion often resolves on its own 1.
- In cases where intervention is necessary, a multidisciplinary approach should be taken, considering the individual patient's needs and the underlying cause of the effusion 1.
- It is essential to note that the literature on "late" postoperative pleural effusions is sparse, and comprehensive investigation should be carried out before attributing the effusion to a postoperative cause 1.
From the Research
Pleural Effusion after Cervical Lymphadenectomy
- Pleural effusion is an excessive accumulation of fluid in the pleural space, which can be related to disorders of the lung or pleura, or to a systemic disorder 2.
- The etiology of pleural effusion remains unclear in nearly 20% of cases, and thoracocentesis should be performed for new and unexplained pleural effusions 2.
- Pleural effusion can occur after cervical surgery, as reported in a case of bilateral pleural effusion following cervical abscess drainage 3.
- The most common causes of pleural effusion are congestive heart failure, cancer, pneumonia, and pulmonary embolism 4.
- Malignant pleural effusions are common in patients with cancer, and most often occur secondary to metastases to the pleura from lung or breast cancer 5.
Diagnosis and Treatment
- Pleural fluid puncture (pleural tap) enables the differentiation of a transudate from an exudate, which is essential for further diagnostic work-up 2, 4.
- Treatment of pleural effusion depends on the underlying etiology, and may include pleurodesis, thoracoscopy, video-assisted thoracoscopy, or the placement of a permanently indwelling pleural catheter 4, 5.
- Persistent postoperative pleural effusion after thoracic surgical interventions requires early diagnosis and adjusted treatment to avoid further complications and shorten the postoperative hospital stay 6.
- Interventional radiological procedures have become a part of the therapy for chylothorax, which can occur after intraoperative injury of the thoracic duct 6.