Mesenteric lymphatic ligation in the prevention of chylous fistulae in abdominal neuroblastoma surgery

Chui, Chan Hon

doi:10.1007/s00383-014-3581-z

Cited by 8 publications

(11 citation statements)

References 11 publications

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“…Increasing rapidly from fasting to oral intake and/or turning clear to milky drainage fluid are the evidences of lymphatic leakage, especially the leakage of gastrointestinal tract [ 14 ]. High fat diet, an extensive amount of double cream [ 25 , 85 ], is used to detect the leakage of lymphatic channels [ 38 , 86 ]. That can be called “chylous lymphangiographic effect” [ 86 ].…”

Section: Resultsmentioning

confidence: 99%

“…High fat diet, an extensive amount of double cream [ 25 , 85 ], is used to detect the leakage of lymphatic channels [ 38 , 86 ]. That can be called “chylous lymphangiographic effect” [ 86 ]. However, another study holds the view that high fat diet only shows the diffusion of lymph leakage [ 57 ], but it's difficult to exactly point out the leakage.…”

Section: Resultsmentioning

confidence: 99%

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A review of the postoperative lymphatic leakage

et al. 2017

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Lymphatic complications are rare, but well-known phenomena, and have been described by many researchers. However, many diagnoses of lymphatic complications are found confusing due to different definition. A literature search in Pubmed was performed for studies postoperative lympatic complications. These complications divided into two parts: lymphatic leakage and lymphatic stasis. This review is about lymphatic leakage, especially, postoperative lymphatic leakage due to the injury of lymphatic channels in surgical procedures. According to polytrophic consequences, many types of postoperative lymphatic leakage have been presented, including lymph ascites, lymphocele, lymphorrhea, lymphatic fistula, chylous ascites, chylothorax, chyloretroperitoneum and chylorrhea. In this review, we focus on the definition, incidence and treatment about most of these forms of lymphatic complications to depict a comprehensive view of postoperative lymphatic leakage. We hold the idea that the method of treatment should be individual and personal according to manifestation and tolerance of patient. Meanwhile, conservative treatment is suitable and should be considered first.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A review of the postoperative lymphatic leakage

et al. 2017

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“…Upon completion of tumour extirpation, radio-opaque clips are placed to mark the most cranial, caudal, medial and lateral margins of the tumour bed, as well as any areas of residual tumour [ 60 ]. Regions with transected lymphatics such as in the retroperitoneum, or around the thoracic duct, may be oversewn with permanent sutures or overlaid with haemostatic agents to reduce the risk of postoperative chyle leak [ 61 , 62 ]. Surgical drains may be left in the operative bed when significant risk of chyle leak is anticipated [ 63 ].…”

Section: Surgical Goalsmentioning

confidence: 99%

“…Pain relief should be maintained via epidural infusions, regional anaesthesia or patient (or nurse) controlled intravenous opioid infusions. It is helpful to resume lipid-containing enteral feeds before removing surgical drains, if present, in order to diagnose occult chyle leaks [ 62 ]. In general, postoperative recovery should be expeditious and not substantially delay resumption of adjuvant therapy.…”

Section: Postoperative Considerationsmentioning

confidence: 99%

International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines

Abib¹,

Chui²,

Cox³

et al. 2022

ecancer

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Most children with tumors will require one or more surgical interventions as part of the care and treatment, including making a diagnosis, obtaining adequate venous access, performing a surgical resection for solid tumors (with staging and reconstruction), performing procedures for cancer prevention and its late effects, and managing complications of treatment; all with the goal of improving survival and quality of life. It is important for surgeons to adhere to sound pediatric surgical oncology principles, as they are closely associated with improved local control and survival. Unfortunately, there is a significant disparity in survival rates in low and middle income countries, when compared to those from high income countries.The International Society of Paediatric Surgical Oncology (IPSO) is the leading organization that deals with pediatric surgical oncology worldwide. This organization allows experts in the field from around the globe to gather and address the surgical needs of children with cancer. IPSO has been invited to contribute surgical guidance as part of the World Health Organization Initiative for Childhood Cancer. One of our goals is to provide surgical guidance for different scenarios, including those experienced in High-(HICs) and Low-and Middle-Income Countries (LMICs). With this in mind, the following guidelines have been developed by authors from both HICs and LMICs. These have been further validated by experts with the aim of providing evidence-based information for surgeons who care for children with cancer.We hope that this initiative will benefit children worldwide in the best way possible.

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“…Other groups gave no further definition of LL in their reports. 17,18 In this study, we defined LL with the amount of fluid per day and with the duration of leakage with a relatively low lower limit of 7 days. Accordingly, one reason for the high incidence is this lower limit, since most of the patients who were categorized in our LL group showed relatively short duration of chylous ascites, as 57% had LL between 8 to 14 days (►Fig.…”

Section: Incidence and Definition Of Lymphatic Leakagementioning

confidence: 99%

Lymphatic Leakage after Surgery for Neuroblastoma: A Rare Complication?

Froeba-Pohl

Muehling

Vill³

et al. 2020

Eur J Pediatr Surg

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Introduction Neuroblastoma is the most common extracranial solid tumor in infancy. It is responsible for around 15% of all oncological deaths during childhood. Due to its retroperitoneal location, neuroblastoma is invasively growing directly in and around the lymphatic duct. Consecutively, lymphatic leakage (LL) after surgery for neuroblastoma is a known complication. The purpose of this study is the investigation of frequency and impact of this complication. Material and Methods Between February 2003 and December 2016, 204 patients with neuroblastoma received surgical treatment in our department. A retrospective analysis for macroscopical extent of resection, duration of drainage postsurgery, maximum amount of fluid drained in 24 hours, MYCN amplification status, therapeutic options for LL, follow-up status, and overall survival was performed. Results A total of 40% of patients (82/204) showed LL to some extent. In patients with MYCN amplification, LL was seen significantly more often than in patients without MYCN amplification status (p = 0.019). LL was also significantly correlated with extent of surgery (p = 0.005). Follow-up status and overall survival were significantly inversely associated with LL (p = 0.004 and p = 0.0001). LL was self-limiting in all cases. There was a trend toward shorter duration of LL if either no special therapy was chosen or total parenteral nutrition (TPN) was administered (p = 0.0603). Conclusion We show that LL in neuroblastoma is a common complication of tumor resection and occurring more often than anticipated. Since, in our study cohort, all cases of LL were self-limiting, we question the indication for invasive therapy besides supporting measures.

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Mesenteric lymphatic ligation in the prevention of chylous fistulae in abdominal neuroblastoma surgery

Abstract: Chylous fistulae complicating abdominal neuroblastoma surgery disrupt neuroblastoma treatment. Meticulous MLL can be preventative if performed routinely before abdominal closure in the primary surgery.

Cited by 8 publications

References 11 publications

A review of the postoperative lymphatic leakage

A review of the postoperative lymphatic leakage

International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines

Lymphatic Leakage after Surgery for Neuroblastoma: A Rare Complication?

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