Three Cases of Chylothorax After Lung Cancer Surgery: Possible Lymphatic Vessel Variation in the Upper Right Mediastinum

ABSTRACT Postoperative chylothorax is an uncommon complication after lung cancer resection. However, chylous leakage caused by iatrogenic injury of aberrant mediastinal lymphatic vessels often presents massive drainage and fails conservative treatment, requiring reoperation. A retrospective analysis was performed on three patients who underwent reoperation for refractory massive chylothorax after radical resection of right upper lobe lung cancer between October 2022 and November 2023 in our center. Intraoperatively, chylous fistulas were consistently detected at the junction of the upper margin of the azygos arch and the anterolateral trachea in the right superior mediastinum. An aberrant lymphatic tubular structure was directly visualized at this anatomical site during one primary operation. Preventive suturing may be considered at this anatomical junction during extensive right superior mediastinal lymphadenectomy to prevent postoperative chylothorax.