A Novel Technique for Reducing the Occurrence of Chylous Fistula After Lateral Neck Lymph Node Dissection for Thyroid Carcinoma: Reverse-Sequence Dissection and Protection of the Thoracic Duct and Right Lymphatic Duct.

This article focuses on evaluating a novel surgical technique—reverse-sequence dissection and protection of the thoracic duct and/or right lymphatic duct—to reduce the incidence of chylous fistula following lateral neck lymph node dissection (LLND) for thyroid carcinoma. In a cohort of 989 patients, those undergoing the reverse-sequence dissection (Group A) experienced a significantly lower rate of postoperative chylous fistula (0.81%) compared to those receiving traditional prophylactic ligation around the venous angle (5.05%). The technique involves careful dissection and ligation of lymphatic branches while preserving the main duct trunk, resulting in reduced chyle leakage volume and fewer severe complications such as chylothorax and Horner syndrome. The study suggests that this approach not only decreases chylous fistula incidence but also allows more thorough lymph node removal near the venous angle, potentially lowering recurrence risk.