Lung resection, a critical treatment for various thoracic diseases, including lung cancer, often necessitates prolonged hospitalization due to rare but severe postoperative complications such as chyle leaks, with an occurrence of 0.25%-3%, prolonging chest drainage, and delaying recovery. Therefore, effective postoperative care is essential for optimizing outcomes, reducing complications, and expediting recovery.
Recent studies have highlighted the significant potential of medium-chain triglyceride (MCT) diets, owing to their unique absorption pathway and metabolic properties. MCT contains mainly medium-chain fatty acids (MCFA), which is absorbed in the intestine and transported to the liver via the portal system instead of the lymphatic system. This helps to bypass the lymphatic system, thereby reducing the volume of lymph. MCFAs also provide better energy utilization in stressed condition since it does not require carnitine shuttle upon metabolism, which is beneficial to post-operation recovery.
Several studies have demonstrated the benefits of MCT diets in managing chyle leaks and supporting gastrointestinal recovery, particularly in conditions that strain the lymphatic system. For instance, short-term MCT-enriched diets have been associated with improved post-operation recovery of gastrointestinal, hepatic and renal functions, reduced total chest drainage volumes, and shorter hospital stay when compared to regular diet groups.
Patients with post-operative chyle leak following thoracic surgery are often given an MCT diet to reduce chest drain volume and hence shorten hospital stay. Based on the successful use of MCT diet on patients with chyle leak after lobectomy, it is hypothesized that patients with chylothorax provided with post-operative MCT diet can also shorten hospital stay by decreasing chest drainage. Therefore, a prospective and randomized trial is designed to investigate how post-operative MCT diet in lung resection patients without chylothorax may affect hospital stay and post-operative recovery.
Age between 18 - 80 years
Body mass index <35 kg/m2
Suitable for minimally invasive surgery
Willingness to participate as demonstrated by giving informed consent
Contraindication to general anesthesia
Severe concomitant illness that drastically shortens life expectancy or increases the risk of therapeutic intervention
Untreated active infection
Non-correctable coagulopathy
Parallel
MCT Diet
Dietary supplementMCT diet for patients following lung resection
hospital length of stay (LOS)
hospital length of stay (LOS), which is hypothesized to be reduced following the administration of an MCT diet. Currently, patients undergoing lobectomy using VATS have a median LOS of approximately 3-4 days. The study aims to investigate whether MCT diet interventions can reduce this to 2 days, representing a 30% reduction in hospital stay.
Total Chest Drain Output (mL)
Chest drain output indirectly reflects recovery status. The total chest drain output will be measured using the Medela digital chest drainage system, which is routinely used for patients undergoing lobectomy. Compared to manual drainage system, this system allows more precise monitoring of fluid output. This information will help evaluate the overall impact of the MCT diet on postoperative recovery, particularly in reducing fluid drainage.
Patient Satisfaction and Tolerability
Patient-reported outcomes will be assessed using a quality of life (QoL) questionnaire, which is an established tool for evaluating recovery after surgery. The questionnaire will include: * Patient satisfaction with their recovery process * Tolerability of the MCT diet * Any challenges experienced during the diet, including adherence and acceptability
Number of Participants with Symptoms Associated with MCT Diet
Patients will be monitored for any gastrointestinal discomfort associated with the MCT diet, including: * Diarrhea * Constipation * Bloating * Increased flatus Reports of these symptoms will be collected during the hospital stay and follow-up visits to assess the safety and tolerability of the MCT diet.
Number of patients with Infection symptoms
· Observing for symptoms such as fever or shortness of breath (SOB), which will be incorporated into the QoL questionnaire
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