Contemporary Lymphangiography-Guided Management of Postoperative Chylothorax in Adults: An Updated Systematic Review and Meta-Analysis.

PURPOSE: To update pooled estimates of technical and clinical success of lymphangiography-guided management of postoperative chylothorax in adults. MATERIALS AND METHODS: PubMed, Embase, and the Cochrane Library were searched from 1998 to January 2026 for studies reporting outcomes of lymphangiography-guided management of postoperative chylothorax in adults. Two reviewers independently screened records and assessed risk of bias with ROBINS-I. Logit-transformed proportions were pooled with DerSimonian-Laird random-effects models, with robustness checked using restricted maximum-likelihood and Hartung-Knapp estimators, prespecified subgroup and era analyses, sensitivity analyses restricted to studies of at least 10 patients and excluding the largest cohorts, publication-bias testing, and GRADE rating of certainty. RESULTS: Of 710 records, 28 studies were included in qualitative synthesis and 17 in meta-analysis. Pooled technical success was 75.3%, up from 63.1% in 2018, and clinical success was 74.5%; both were stable under restricted maximum-likelihood and Hartung-Knapp models, when restricted to studies of at least 10 patients (73.1% and 72.3%), and on leave-one-out analysis. Clinical success was numerically higher after esophagectomy (82.6%) than in mixed-origin cohorts (73.9%), but subgroup intervals were wide and overlapping. No covariate explained the substantial heterogeneity (I-squared 68-80%). Egger testing indicated asymmetry for clinical (P = .03) but not technical success (P = .65). Certainty of evidence was low to very low. CONCLUSION: Lymphangiography-guided management estimates are heterogeneous, of low certainty, and non-comparative. Their interpretation is limited by inconsistent definitions of success, the absence of comparative studies, and other factors; standardized reporting and head-to-head studies are needed before efficacy can be determined. STUDY REGISTRATION: PROSPERO CRD420261388785. LEVEL OF EVIDENCE: Level 4 (systematic review and meta-analysis of observational studies).