Radiotherapeutic management of the chyloperitoneum following abdominal aortic aneurysm repair

Purpose:Chylous ascites (CA) is an uncommon complication that occurs from traumatic disruption of lymphatic channels after retroperitoneal surgery. The purpose of this study was to generate an evidence-based management strategy for CA by reviewing the current literature and available treatment modalities.Materials and Methods:A MEDLINE® literature review was performed for “chylous ascites.” Individual patient data were extracted from case series and reports to create an efficacy analysis. Treatment modality, drain output, time to escalation of care and time to resolution were recorded. The efficacy analysis was utilized to generate a data-driven treatment algorithm.Results:The literature review yielded 1,953 articles, from which 146 studies contributed data for 523 patients. The efficacy analysis included 245 patients, 168 (69%) of whom were managed successfully with conservative management (CM), at a median time to resolution of 11 days. Forty-eight patients underwent lymphangiography±embolization after CM, with a success rate of 85%. Thirty-one (12%) patients underwent surgical exploration. When treating CA, the patients who underwent stepwise management with CM followed by lymphangiography if CM failed experienced a resolution rate of 96.7%. An evidence-based treatment algorithm was created to guide treatment selection and duration of therapy before escalating to additional forms of therapy.Conclusions:In this report, we describe the largest conglomeration of iatrogenic CA cases from a literature review (523 cases) and efficacy analysis (245 cases), and created the first evidence-based treatment algorithm for this condition. Treatment success is substantial when using a stepwise combination of CM followed by lymphangiography±embolization.

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“…In our review, surgery was unsuccessful in controlling CA in only 1 case that was then managed with 5 cycles of external beam radiation. 50…”

Section: Resultsmentioning

confidence: 99%

“…In our review, surgery was unsuccessful in controlling CA in only 1 case that was then managed with 5 cycles of external beam radiation. 50 Efficacy Analysis. Efficacy data were available for 245 patients from 85 studies (Table 2, and the supplementary Figure and Table, https://www.jurology.…”

Section: Peritoneal Drainagementioning

confidence: 99%

Contemporary Management of Chylous Ascites after Retroperitoneal Surgery: Development of an Evidence-Based Treatment Algorithm

et al. 2022

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“…Ohki et al [ 15 ] treated a patient who developed chylous ascites after AAA repair with total parenteral hyper-alimentation for 10 days following a low-fat diet. Perez et al [ 16 ] treated a patient who developed chylous ascites after AAA surgery with conservative and surgical treatment. But, because the patient did not respond to the treatment, they treated the patient with five cycles of retroperitoneal radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Chylous Ascites Developing after Open Thoracoabdominal Aortic Aneurysm Repair in a Patient with Marfan Syndrome

Kara

2020

Braz J Cardiovasc Surg

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Chylous ascites is the pathologic accumulation of chylous fluid in the peritoneal cavity, caused by lymphomas, metastatic malignancies, and abdominal surgeries, rarely due to surgical trauma of the cisterna chyli or its major branches. A 24-year-old man with history of Marfan syndrome presented to our hospital with abdominal distention, abdominal pain, fluid in the incision region, and weakness. He had underwent an elective open aneurysm repair surgery nine days before for thoracoabdominal aortic aneurysm. Computed tomography revealed massive fluid collection in the abdominal cavity, which was drained surgically. He was diagnosed with chylous ascites and was discharged after conservative treatment.

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“…The median duration of conservative management strategies for resolution of chylous leakage ranged from 3.5 to 29 days [ 1 ]. The adequate time to assess the efficacy of conservative treatments is 6 to 8 weeks [ 5 ]. Surgical or interventional approaches such as ligation or peritoneovenous shunts can be considered for massive chylous leakage that is refractory to conservative management strategies, generally defined as the total amount of drainage fluid >500 mL/day.…”

Section: Discussionmentioning

confidence: 99%

Low-dose radiation therapy for massive chylous leakage after subtotal gastrectomy

Kim

2017

Radiat Oncol J

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Massive chylous leakage is a rare postoperative complication that can prolong hospital stay and cause secondary morbidities. Conservative management strategies are the treatment of choice; however, radiation therapy (RT) can be used as an alternative for cases that are refractory to conservative treatment. Herein, we report a 69-year-old female patient who suffered from massive chylous leakage after subtotal gastrectomy. Due to persistent massive chylous leakage, she was scheduled to undergo low-dose RT. Radiation was delivered with a daily dose of 1 Gy, using an anterior-posterior and posterior-anterior beam arrangement. The clinical target volume encompassed the entire lymph node area of the D2 dissection. RT was completed at the total dose of 8 Gy because the amount of chylous leakage declined rapidly. Percutaneous drainage tube was removed after 3 days of RT. The patient did not complain of any symptoms related to massive chylous leakage 2 years after the completion of RT.

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Radiotherapeutic management of the chyloperitoneum following abdominal aortic aneurysm repair

Cited by 4 publications

References 18 publications

Contemporary Management of Chylous Ascites after Retroperitoneal Surgery: Development of an Evidence-Based Treatment Algorithm

Contemporary Management of Chylous Ascites after Retroperitoneal Surgery: Development of an Evidence-Based Treatment Algorithm

Chylous Ascites Developing after Open Thoracoabdominal Aortic Aneurysm Repair in a Patient with Marfan Syndrome

Low-dose radiation therapy for massive chylous leakage after subtotal gastrectomy

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