Significant progress has been made toward understanding the tumorigenic role and clinical significance of the T1799A B-type Raf kinase(BRAF)mutation in papillary thyroid cancer(PTC). With these advances, it has become clearer that BRAF mutation will likely have significant impact on the clinical management.

Objective:To investigate the efficacy and safety of thoracic duct repair in the treatment of iatrogenic thoracic duct injury in thyroid surgery.Methods:Clinical data of 2 759 cases with lymph nodes metastasis from papillary thyroid carcinomas at two tertiary referral academic medical centers, viz. Tongji Hospital of Huazhong University of Science and Technology and Zhongnan Hospital of Wuhan University were retrospectively analyzed, of which 69 cases encountered injured thoracic duct. Thirty patients received thoracic duct ligation (ligation group) before Jun. 2016, and thirty-nine with direct suture repair of lacerated duct (repair group). Age, sex, cervical clearance surgery, lymph node dissection, lymph node metastasis, whether lymph nodes were invaded extracapsular, chest catheter injection into venous points, and operation time were recorded.Results:In the thoracic duct direct suture repair group, 39 patients with a mean age of (43.2±9.3) successfully performed intraoperative thoracic duct sutures and only one patient developed CL postoperatively. In the thoracic duct ligation group, 30 ducts with a mean age of (49.5±10.0) were successfully ligated during the operation, and 5 (16.7 %) still developed CL after operations, with the highest daily drainage volume of more than 500 ml, and the median duration of chylous leakage of 3 days. The incidence of CL in the thoracic duct direct suture repair group was significantly lower than that in the ligation group (0 vs 16.7%, P=0.013), and the length of hospital stay in the repair group was also significantly shorter (6.1 (6.0,6.5) vs 10.0 (9.0,10.0) day, Z=-7.21, P=0.014) .There was no significant difference in operation time between the two groups (110.9±8.7 vs 109.3±7.9, t=0.82, P=0.421) . Conclusion:Compared with thoracic duct ligation, thoracic duct direct suture repair in patients with intraoperative thoracic duct injury may be an effective method to reduce postoperative CL.