Chylous ascites after colorectal cancer surgery: risk factors and impact on short-term and long-term outcomes

Lee, Soo Young; Kim, Chang‐Hyun; Kim, Young Jin; Kim, Hyeong Rok

doi:10.1007/s00423-016-1500-6

Cited by 15 publications

(37 citation statements)

References 21 publications

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“…D3 extended mesenterectomy entails the removal of all fatty tissue from the predefined D3 area [ 2 ], made possible and safe through preoperative 3D multi-detector computed tomography (MDCT) vascular anatomy reconstruction [ 3 , 4 ]. Literature suggests that the incidence of chylous ascites after surgery, i.e., urological, gynecological, vascular, and liver (non-intestinal lymph), is estimated to be between 0.17 and 7.0% [ 5 ], while the incidence rates may be higher after gastric, colorectal, pancreatic, and small bowel surgery (intestinal lymph) with a rate between 1.0 and 11.8% [ 1 , 5 , 6 ]. Reports on the incidence rates of chylous ascites after D3 extended mesenterectomy are scarce in the literature.…”

Section: Introductionmentioning

confidence: 99%

Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy

Agustsdottir

Štimec

Stroemmen

et al. 2020

Langenbecks Arch Surg

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Background We aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect. Methods Data from 138 patients included in a D3 extended mesenterectomy trial were collected prospectively. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was then implemented in the next 99 patients as a prophylactic measure. Results In the first 39 patients, we found that 16 (41.0%) developed chylous ascites. After the fat-reduced diet was implemented, 1 (1.0%) of 99 patients developed chylous ascites. Drain discharge was 150 vs. 80 mL daily, respectively, and a regression analysis shows the average leakage in the group with fat-reduced diet was 105 mL/day less than in the patients with no dietary restrictions (p < 0.001). There were no significant differences in the rate of other complications (Fisher exact test, one-tailed p = 0.8845), and although there was a tendency to a shorter hospital stay when given a fat-reduced diet (7.3 ± 5.4 vs. 8.9 ± 4.9 days), the difference was not significant (p = 0.19). Conclusions Chylous ascites is a very common postoperative occurrence after right colectomy with extended D3 mesenterectomy and may be prevented using a routine fat-reduced diet.

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Section: Introductionmentioning

confidence: 99%

Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy

Agustsdottir

Štimec

Stroemmen

et al. 2020

Langenbecks Arch Surg

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“…Previous data showed that chylous ascites in patients after colorectal surgery didnot affect their survival [7]. However, a limited report of a small sample size showed a higher rate of cancer recurrence in patients with chylous ascites.…”

Section: Discussionmentioning

confidence: 91%

“…Postoperative chylous ascites is caused by direct surgical trauma to the major lymphatic tributaries. Recent studies showed that long-term outcomes were not affected by the presence of chylous ascites [7]. However, chylous ascites is known to prolong hospital stays by necessitating treatment with total parenteral nutrition or a medium-chain triglyceride diet [5].…”

Section: Introductionmentioning

confidence: 99%

Impact of Chylous Ascites on Colon Cancer in Laparoscopic Surgery

Munakata¹,

Sakamoto²,

Honjo³

et al. 2018

OJGas

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Objectives: To investigate the epidemiology and risk factors of chylous ascites. Methods: We identified the cases of 913 consecutive patients who under went urgery for colorectal cancer at our University Hospital between January 2005 and December 2016. We divided the patients into those with and those without chylous ascites and compared the two groups by age, gender, body mass index, tumor location, T, N factor, stage, operation time, intra-operative bleeding, and duration of postoperative hospital stay. Results: Chylous ascites developed in 8 of the 913 patients (0.8%). Neither age, sex, tumor location, and body mass index nor number of lymph nodes were associated with postoperative chylous ascites. Ascites occurred significantly less frequently in the early stage of colorectal cancer than in the late stage (p = 0.04). There was no significant difference between the groups in operative factors, including operation time and blood loss. Postoperative hospital stays were longer in patients with chylous ascites (20.5 days) than in those without (11 days) (p = 0.02). Conclusions: Late stage was one of the risk factors for chylous ascites in the present study. Other risks, such as tumor location and blood loss, will vary from institution to institution.

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“…11 articles reported the dissecting equipment used including ultrasonic coagulating shears, electrothermal bipolar vessel sealers and/or electrosurgery[ 1 , 2 , 10 , 13 , 17 , 22 , 24 , 25 , 27 , 28 , 34 ] (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…There was no uniformity in the definition of CL/CA in four studies that defined it[ 1 , 2 , 13 , 17 ]. Most commonly, diagnosis was based on the appearance of typical non-infected, white milky fluid from surgical drains.…”

Section: Resultsmentioning

confidence: 99%

Chylous ascites in colorectal surgery: A systematic review

Ng¹,

Han²,

Beh³

et al. 2021

WJGS

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BACKGROUND Chylous ascites is a rare complication in colorectal surgery with limited evidence. AIM To systematically review all available evidence to describe the incidence, clinical presentation, risk factors and management strategies. METHODS The systematic review was performed through PubMed, MEDLINE, EMBASE and Cochrane and cross-checked up to November 2020. The data collated included: Demographics, indications (benign vs malignant), site of disease, surgical approach, extent of lymphadenectomy, day to and method of diagnosis of chylous ascites and management strategies. RESULTS A total of 28 studies were included in the final analysis (426 cases). Patient age ranged from 31 to 89 years. All except one case were performed for malignancy. Of the 426 cases, 195 were right-colonic, 121 left-colonic, 103 pelvic surgeries and 7 others. The majority were diagnosed during the same inpatient stay by recognition of typical drain appearance and increased volume. Three cases were diagnosed during outpatient visits with increased abdominal distention and subsequently underwent paracentesis. Most cases were managed successfully non-operatively (fasting with prolonged drainage, total parenteral nutrition, somatostatin analogues or a combination of these). Only three cases required surgical intervention after failing conservative management and subsequently resolved completely. Risk factors identified include: Right-colonic surgery/ tumour location, extent of lymphadenectomy and number of lymph nodes harvested. CONCLUSION Chylous ascites after colorectal surgery is a relatively rare complication. Whilst the majority of cases resolved without surgical intervention, preventative measures should be undertaken such as meticulous dissection and clipping of lymphatics during lymphadenectomy to prevent morbidity.

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Chylous ascites after colorectal cancer surgery: risk factors and impact on short-term and long-term outcomes

Cited by 15 publications

References 21 publications

Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy

Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy

Impact of Chylous Ascites on Colon Cancer in Laparoscopic Surgery

Chylous ascites in colorectal surgery: A systematic review

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