Background Chylous ascites (CA) is a rare complication of gastrectomy for gastric cancer. While most cases of postoperative CA improve with medication or nutritional support, some are refractory to conservative treatment. A peritoneovenous shunt (PVS) may help patients who are poor candidates for surgery. However, PVS placement for postoperative CA after gastroenterological surgery has been rarely reported. Herein, we present a case of postoperative CA following total gastrectomy with para-aortic lymphadenectomy, treated successfully by PVS placement. Case presentation A 74-year-old man who underwent total gastrectomy with para-aortic lymph node dissection was hospitalised because of insufficient oral intake and dehydration. His abdomen was markedly distended with severe bilateral lower extremity oedema. On admission, abdominal computed tomography (CT) showed a high volume of ascites and no signs of cancer recurrence. Accordingly, postoperative CA resulting from drainage of fluid on paracentesis was diagnosed. Despite nutritional support, diuretics, and octreotide administration, his abdominal distension and nutritional status did not improve. We could not identify the sites of lymphatic leakage in the three intranodal lymphangiographies followed by CT. Although we considered a surgical treatment in our patient, we decided against it. Because we could not identify lymphatic leakage site during lymphangiography, surgical treatment might have a potential failure of detection and closure of leakage site. Furthermore, the patient’s general condition was poor because of malnutrition resulting from the loss of lymphatic fluid. Consequently, we decided to place PVS. After PVS placement, his abdominal distension improved rapidly, and he was discharged without serious complications. Thirteen months after PVS, patient has no relapse of abdominal distention and nutrition status has improved. Conclusion PVS might be a good option to manage refractory postoperative CA, as the leakage point cannot be detected on lymphangiography.
Background: We analyzed clinicopathologic variables and postoperative outcomes in patients with ampulla of Vater carcinoma (AVC) to identify key predictors of post-resection prognosis.Methods: Fifty-five patients who underwent pancreaticoduodenectomy for AVC with curative intent between 2005 and 2020 were included in this study. A retrospective review of the clinical records of patients who underwent surgical exploration for AVC was performed using univariate and multivariate analyses. Clinical and pathological factors that influenced patient survival were analyzed. Results: One-, 3-, and 5-year overall survival rates after surgery were 97.4%, 71.8%, and 63.0%, respectively. A total of 21 patients developed recurrent disease after curative resection for AVC. The most frequently observed sites of recurrence were lymph nodes in 11 patients (52%), followed by the liver in 8 (38%), lung in 6 (29%), local in 3 (14%), and peritoneal dissemination in 3 (14%). Estimated 3- and 5-year recurrence free survival rates for the entire cohort were 62.8% and 57.2%, respectively. On multivariate analysis, only the presence of lymph node metastasis extending to the pancreatic head region (hazard ratio = 5.374; 95% confidence interval: 1.279–22.58; P = 0.022) predicted inferior relapse-free survival. A significant correlation between postoperative recurrence and pathological lymph node metastasis was observed. Conclusions: Lymph node metastasis, especially that which extends to the pancreatic head region, was clearly identified as a prognostic indicator of reduced relapse-free survival in patients who have undergone curative surgical treatment for AVC.
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