Fig. 1

A The second and fourth group lymph node dissection (arrow) at the first operation. B Operative finding of the second operation. Adhesions have formed below the arch of azygos vein and the upper right lung (arrow). C A diffuse chylous leak is identified as originating from the tributary channels at the site of dissection of the station 4R lymph nodes (arrow). D Tributary channels are clamped using titanium clips