Radiological Management of Chyle Leaks Following Oesophagectomy: A Systematic Review.

A chyle leak is a rare but potentially life-threatening complication following oesophagectomy. If untreated, it can result in hypovolaemia, malnutrition, electrolyte imbalance, and immunosuppression. Traditionally managed with surgical ligation, radiological interventions have emerged as less-invasive alternatives, though their comparative efficacy remains uncertain. This paper aims to systematically review the literature on the efficacy, safety, and clinical outcomes of radiological interventions for managing chyle leaks following oesophagectomy. An electronic search of PubMed (Medline) was performed on 8th May 2024 using the terms "Chyle Leak," "Chylothorax," (accumulation of chyle within the pleural space), and "Oesophagectomy." Eligible studies included patients with chyle leak post-oesophagectomy who underwent radiological interventions such as lymphangiography, thoracic duct embolisation (TDE), or thoracic duct disruption (TDD). Outcomes assessed included technical and clinical success rates, complications, and comparisons with surgical or conservative management. Both retrospective and prospective studies, case series, and case reports were included due to the limited data available related to the condition, specifically post-oesophagectomy. Data were synthesised qualitatively.  Of 448 studies identified, 38 met the inclusion criteria. The majority were retrospective reviews, case series, and case reports. Lymphangiography, with or without TDE/TDD, was the most frequently described intervention, demonstrating technical success rates exceeding 85% in most studies. Clinical resolution rates varied from 56% to 100%. Lymphangiography alone was often both diagnostic and therapeutic, with some studies reporting cure rates of up to 70%. Intranodal lymphangiography (INL) was often noted to have higher technical success than pedal lymphangiography (PL). Complications were uncommon and generally minor, though isolated cases of biliary fistula, haematoma, and Acute Respiratory Distress Syndrome (ARDS) were reported. Novel techniques such as MRI, CT-guided interventions, and lymphoscintigraphy demonstrated feasibility in case reports but lack high-powered validation.  Radiological interventions, particularly lymphangiography with or without TDE/TDD, are safe, minimally invasive, and increasingly effective alternatives to surgical ligation for managing chyle leaks after oesophagectomy. While the available evidence supports their early use, the literature is limited by heterogeneity, small sample sizes, and predominance of retrospective designs. Further prospective studies and standardised reporting are required to establish radiological intervention as the gold standard of management in chyle leak and to define its role relative to surgery.