SynthesisFrontiers in oncology2026
Incidence and management outcomes of chylothorax after pulmonary resection for primary lung cancer: a systematic review and meta-analysis.
Synthesis in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Chylothorax is an uncommon but clinically important complication of pulmonary resection for primary lung cancer and may complicate postoperative management and require treatment escalation. However, quantitative syntheses of its incidence and management outcomes are lacking. This meta-analysis pooled chylothorax incidence, the proportions of patients successfully treated non-surgically and receiving subsequent surgical or interventional treatment, and summarized clinical and management characteristics. Methods: Following PRISMA 2020, PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were searched from inception to May 5, 2026. Original studies reporting incidence or management outcomes of postoperative chylothorax after pulmonary resection for primary lung cancer were included. Methodological quality was assessed with the JBI Critical Appraisal Checklist for Prevalence Studies. Random-effects single-proportion meta-analyses were performed. Exploratory subgroup analyses and meta-regression examined incidence; sensitivity analyses and assessments of small-study effects were conducted for the pooled outcomes. Results: Twenty-eight studies involving 212,637 patients were included, with 1,798 cases of postoperative chylothorax. The pooled incidence was 1.4% (95% CI: 1.0%-1.7%; I²=94.87%). Subgroup analyses by surgical approach and diagnostic criteria showed no significant between-subgroup differences, with high within-subgroup heterogeneity. Across 23 studies, the pooled proportion successfully treated non-surgically was 86.9% (95% CI: 82.0%-91.2%; I²=49.73%). Across 22 studies, the pooled proportion receiving subsequent surgical or interventional treatment was 12.8% (95% CI: 8.4%-17.9%; I²=52.32%). Leave-one-out and GLMM-based sensitivity analyses supported the robustness of the pooled estimates. Egger's regression suggested a possible small-study effect for incidence, but trim-and-fill adjustment did not materially change the pooled estimate. Narrative synthesis showed variation in diagnostic criteria, initial non-surgical regimens, escalation strategies, and definitions and reporting of management outcomes. Conclusion: Chylothorax after pulmonary resection for primary lung cancer has a low incidence, but its management burden should not be overlooked. Most cases were controlled with initial non-surgical treatment, whereas some required subsequent surgical or interventional treatment. Diagnostic and treatment-escalation criteria remain inconsistent. Future studies should prespecify and validate diagnostic and treatment-escalation criteria and standardize the definition of successful non-surgical treatment and outcome reporting to improve comparability and provide more reliable evidence for postoperative surveillance and clinical management decisions. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261392561, identifier CRD420261392561.
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