Right-sided chyle leaks, an institutional experience of over 4,000 neck dissections and scoping review of incidence and management

Background: Right-sided chyle leaks are an uncommon but potentially severe complications in neck surgery. While the prevalence of chyle leaks on the left side of the neck, often resulting from damage to the thoracic duct, is well-documented, there is limited literature addressing right-sided chyle leaks. This study aims to highlight the prevalence of right-sided chyle leaks in a high-volume Head and Neck unit, provide an overview of the anatomy and variations of the lymphatic system in the right side of the neck, and conduct a scoping review of the literature with regard to its prevalence and management. Methods: A retrospective analysis was conducted of right-sided neck dissections performed at the Sydney Head and Neck Cancer Institute between 2014 and 2023. Patient charts were individually examined to determine the local prevalence of postoperative right-sided chyle leaks. A scoping review of existing scientific literature was performed to identify the existing prevalence and management regimes of right-sided chyle leaks. Results: Among 4,547 right-sided neck dissections performed during the study period, five cases of right-sided chyle leaks were identified (0.11% prevalence), with two (40%) of these cases consisting of high-volume leaks which required a return to theatre. The scoping review identified 14 publications for inclusion, these reported an incidence of chyle leaks ranging from 0.75% to 8.9%. Conclusions: High volume right-sided chyle leaks occur infrequently and may be due to the presence of anastomosis between the right and left sided thoracic ducts. It is imperative that Head and Neck surgeons remain vigilant in lymphatic duct ligation in both right and left-sided neck dissections.