A review of the postoperative lymphatic leakage

Lv, Shulan; Wang, Qing; Zhao, Weichen; Han, Lu; Wang, Qi; Batchu, Nasra; Ulain, Qurat; Zou, Junkai; Sun, Chao; Du, Jiang; Song, Qing; Li, Qiling

doi:10.18632/oncotarget.17297

Cited by 154 publications

(188 citation statements)

References 105 publications

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“…The chylous leak appears between 3 and 8 days postsurgery . It could be in isolation as observed by us or in association with other common postpancreatectomy complications.…”

Section: Discussionsupporting

confidence: 59%

Management of chylous ascites following pancreaticobiliary surgery

et al. 2019

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Background Chyle leak is an uncommon form of ascites occurring due to the accumulation of lipid‐rich lymph into the peritoneal cavity. Traumatic injury to the lymphatic system due to pancreaticobiliary surgery can lead to this phenomenon. Method We retrospectively evaluated the data of 159 patients of pancreticobiliary surgery from January 2012 to December 2016. Five patients (5/137, 3.6%) sustained a chylous leak following pancreaticoduodenectomy and one patient (1/22, 4.5%) sustained a chylous leak following Roux‐en‐Y hepaticojejunostomy for postcholecystectomy biliary stricture. Results Average daily output was 441 mL (range: 150–800 mL/day), and total duration of output was 16.5 days (range: 4–35 days). Mean hospital stay increased to 19.1 days (range: 10–40 days). All the patients were successfully managed conservatively with a combination of customized enteral feeds, supplemental parenteral nutrition, and octreotide. One patient required additional percutaneous drainage. Conclusion Chyle leak can be successfully treated with conservative management but at the cost of increased hospital stay.

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“…The chylous leak appears between 3 and 8 days postsurgery . It could be in isolation as observed by us or in association with other common postpancreatectomy complications.…”

Section: Discussionsupporting

confidence: 59%

Management of chylous ascites following pancreaticobiliary surgery

et al. 2019

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“…Different types of surgical procedures may injure lymph ducts and lymph nodes, resulting in postoperative lymphatic leakage (PLL) as a difficult-to-treat and potentially life-threatening complication [1]. PLL can occur anywhere in the body along the lymphatic system, leading to the pathological accumulation of lymph or chyle (e. g. chylothorax and lymphatic ascites or chylous ascites) [1,2]. Lymph can also leak through percutaneous tracts in the form of a lymph fistula, which is associated with or without diffuse or localized lymph collections (e. g. lymphocele) [3].…”

Section: Introductionmentioning

confidence: 99%

“…Refractory PLL can significantly affect postoperative recovery time, wound healing, and quality of life. High-output PLL increases morbidity and mortality among patients due to lymphocytopenia, protein loss, fat loss, malnutrition, respiratory distress, and immune suppression [1,[3][4][5]. For the past three decades, conservative and surgical treatments have defined the standard for managing PLL.…”

Section: Introductionmentioning

confidence: 99%

Conventional Lymphangiography (CL) in the Management of Postoperative Lymphatic Leakage (PLL): A Systematic Review

Sommer

Pieper

Itkin³

et al. 2020

Rofo

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Background Postoperative lymphatic leakage (PLL) is usually managed by conservative and/or surgical treatments but these procedures can be challenging to perform and potentially clinically ineffective. Therefore, conventional lymphangiography (CL) has emerged as an important alternative. The aim of this review is to present the available outcome data on CL in the management of PLL. Method A systematic literature search (PubMed) using the MeSH term “lymphangiography” was performed and the search was restricted to literature published between January 2007 and August 2019. Identification, screening, and assessment for eligibility and inclusion were conducted in accordance with PRISMA. Results From the initially obtained 1006 articles (identification), 28 articles with a total of 201 patients were finally included (inclusion). The methodological quality of all included articles corresponds to level 4 (Oxford Centre for Evidence-based Medicine – Levels of Evidence, March 2009). PLL occurs after oncological and non-oncological surgery in the form of chylothorax, chylous ascites, and cervical, thoracic, abdominal and peripheral lymph fistula and/or lymphocele. The technical success rate of CL is 75–100 %. Access for CL is transpedal (176 patients) or intranodal (25 patients). Lipiodol is used as the contrast material in all articles, with a maximum amount of 20 ml for transpedal CL and 30 ml for intranodal CL. The X-ray imaging modalities used for CL are fluoroscopy, radiography and/or CT. Two articles report CL-associated major complications and CL-associated morbidity and mortality. The PLL cure rate is 51–70 % for transpedal CL (time to PLL cure: 2–29 days) and 33–100 % for intranodal CL (time to PLL cure: 2–< 30 days). Bailout procedures in the case of clinically ineffective CL include a range of treatments. Conclusion CL is feasible, safe, and effective in the management of PLL. Lipiodol as the contrast material is essential in CL because the highly viscous iodinated poppy-seed oil has not only diagnostic but therapeutic effects. Guidelines and randomized controlled trials are further steps towards defining the ultimate value of CL. Key Points: Citation Format

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“…Lymph is rich in a variety of growth factors, and lymph spillage in addition to bleeding following lymphatic vessel or node resection may in part contribute to dedifferentiating the LMCs surrounding lymphatic vasculature. 45,46 While very little has been published on the effect of growth factors on LMC, vascular smooth muscle cell (VSMC) is very responsive to components of serum such as platelet-derived growth factor and IGF, which have been shown to induce proliferation, and migration in VSMCs. VSMC proliferation is accompanied by a loss in contractile force generation and increase in ECM synthesis.…”

Section: Discussionmentioning

confidence: 99%

In vitro model reveals a role for mechanical stretch in the remodeling response of lymphatic muscle cells

et al. 2018

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Objective: Using primary lymphatic muscle cells (LMCs) in vitro we sought to characterize the impact of LMC remodeling on their functional and molecular response to mechanical loading and culture conditions. Methods: Primary “wounded leg” LMCs were derived from the hindlimb of three sheep who underwent lymphatic injury six weeks prior, while “control leg” LMCs were derived from the contralateral, unwounded, limb. Function of the LMCs were characterized in response to media of variable levels of serum (10% vs 0.2%) and glucose (4.5g/L vs 1g/L). Functional and proteomic data was evaluated in LMCs exposed to cyclic stretch (0.1Hz, 7.5% elongation) for 1 week. Results: LMCs were sensitive to changes in serum levels, significantly reducing overall activity and collagen synthesis under low serum conditions. LMCs from the remodeled vessel had higher baseline levels of metabolic activity but not collagen synthesis. Cyclic loading induced cellular alignment perpendicular to the axis of stretch and alterations in signaling pathways associated with metabolism. Remodeled LMCs had consistently higher levels of metabolic activity and were more resistant to strain induced apoptosis. Conclusions: LMCs exist on a functional spectrum, becoming more active in response to stretching and maintaining phenotypic remodeling in response to local lymphatic/tissue damage.

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A review of the postoperative lymphatic leakage

Cited by 154 publications

References 105 publications

Management of chylous ascites following pancreaticobiliary surgery

Management of chylous ascites following pancreaticobiliary surgery

Conventional Lymphangiography (CL) in the Management of Postoperative Lymphatic Leakage (PLL): A Systematic Review

In vitro model reveals a role for mechanical stretch in the remodeling response of lymphatic muscle cells

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