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Aly AK, Santos E, Fung J, Maybody M, Youssef EW, Petre EN, Gonzalez-Aguirre AJ, Moussa AM. Intranodal Lymphangiography and Embolization for Management of Iatrogenic Chylous Ascites after Oncological Surgery. J Vasc Interv Radiol 2024; 35:883-889. [PMID: 38789205 DOI: 10.1016/j.jvir.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/21/2024] [Accepted: 02/15/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE To investigate the safety and effectiveness of intranodal lymphangiography (INL) and lymphatic embolization (LE) in management of chylous ascites after oncologic surgery. MATERIALS AND METHODS Retrospective review of records of patients who underwent INL with or without LE from January 2017 to June 2022 was performed. Adult patients with chylous ascites after oncologic surgery referred to interventional radiology after failure of conservative treatment were included. Thirty-nine patients who underwent 55 procedures were included (34 males and 5 females). Data on patient demographics, procedural technique, outcomes, and follow-up were collected. Descriptive statistics were used to illustrate technical success, clinical success, and adverse events. Univariate logistic regression analysis was performed to evaluate factors predicting clinical success. RESULTS INL was technically successful in 54 of 55 procedures (98%; 95% confidence interval [CI], 90%-100%). A lymphatic leak was identified in 40 procedures, and LE was attempted in 36. LE was technically successful in 33 of the 36 procedures (92%; 95% CI, 78%-98%). Clinical success, defined as resolution of ascites with no need for peritoneovenous shunt placement or additional surgery, was achieved in 22 of 39 patients (56%; 95% CI, 40%-72%). Clinical success was achieved in 18 patients after 1 procedure, and patients who required repeat procedures were less likely to achieve clinical success (odds ratio, 0.16; 95% CI, 0.04-0.66; P = .012). Four grade 1 procedural adverse events were recorded. CONCLUSIONS INL with or without LE is a safe minimally invasive tool that can help patients with chylous ascites after oncologic surgery who failed conservative treatment avoid more invasive interventions.
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Affiliation(s)
- Ahmed K Aly
- Division of Interventional Radiology, Department of Radiology, MedStar Health, Columbia, Maryland.
| | - Ernesto Santos
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jasmine Fung
- Touro College of Osteopathic Medicine, New York, New York
| | | | - Eslam W Youssef
- Division of Interventional Radiology, Department of Radiology, Indiana University, Bloomington, Indiana
| | - Elena N Petre
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adrian J Gonzalez-Aguirre
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amgad M Moussa
- Division of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Utilization of the medical chest and abdominal belt for the treatment of postoperative cervical lymphatic leakage. Asian J Surg 2023; 46:1452-1453. [PMID: 36153265 DOI: 10.1016/j.asjsur.2022.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/20/2022] Open
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Zhou M, Behera TR, Xu B, Shen Q. Conservative management of a lymphocele that formed shortly after creation of an arteriovenous fistula for hemodialysis. Hemodial Int 2023; 27:E9-E11. [PMID: 36376025 DOI: 10.1111/hdi.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
Patients with end-stage renal disease require to establish vascular access for regular hemodialysis. The creation of arteriovenous fistula (AVF) is usually a safe procedure; however, there could be complications such as bleeding, hematoma, pseudoaneurysm, thrombosis, infection, and steal syndrome. A rare complication of such vascular manipulation could be formation of lymphocele. We present a case of a 67-year-old man who presented with a progressively enlarging mass 12 days after the surgery for AVF creation at the site of surgery in the right upper arm. Ultrasonographic examination revealed a fluid-filled cystic structure measuring about 4.2 × 3.6 × 1.9 cm under the skin just above the anastomosis. The fluid was aspirated using ultrasound-guided fluoroscopy that relieved the swelling. The analysis of aspirate suggested the cyst to be a lymphocele. The mass re-enlarged to its previous size in the next 3 days. While under observation for signs of complication, regular intermittent compression and a low-fat diet completely resolved the lymphocele over the subsequent 3 months. The less common occurrence of such lymphocele post AVF creation needs to be evaluated for its potential for complication, in the absence of which the lymphocele is amenable to conservative management using regular intermittent compression and low-fat oral diet.
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Affiliation(s)
- Meixia Zhou
- Department of Nephrology, Tiantai People's Hospital, Taizhou, Zhejiang, China
| | | | - Beilei Xu
- Department of Nephrology, Tiantai People's Hospital, Taizhou, Zhejiang, China
| | - Quanquan Shen
- Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
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Torres OJM, Valleta NH, Moraes-Junior JMA, Falcão MV, Quariguasi JML, Faria IM. LIPIODOL LYMPHANGIOGRAPHY AND EMBOLIZATION OF CHYLOUS ASCITES AFTER PANCREATODUODENECTOMY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1677. [PMID: 36102487 PMCID: PMC9462857 DOI: 10.1590/0102-672020220002e1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Orlando Jorge Martins Torres
- Hospital São Domingos, Department of Gastrointestinal Surgery – São Luiz (MA), Brazil,Universidade Federal do Maranhão, Department of Gastrointestinal and Transplant Surgery – São Luiz (MA), Brazil
| | | | - José Maria Assunção Moraes-Junior
- Hospital São Domingos, Department of Gastrointestinal Surgery – São Luiz (MA), Brazil,Universidade Federal do Maranhão, Department of Gastrointestinal and Transplant Surgery – São Luiz (MA), Brazil
| | - Milena Vasconcelos Falcão
- Universidade Federal do Maranhão, Department of Gastrointestinal and Transplant Surgery – São Luiz (MA), Brazil
| | | | - Igor Murad Faria
- Hospital São Domingos, Department of Interventional Radiology – São Luiz (MA), Brazil
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Souza KPD, Gilberto GM, Mariotti GC, Falsarella PM, Galastri FL, Korkes F, Garcia RG. Transafferent nodal embolization for lymphocele treatment: case report. EINSTEIN-SAO PAULO 2022; 20:eRC6889. [PMID: 35976354 PMCID: PMC9377309 DOI: 10.31744/einstein_journal/2022rc6889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/02/2021] [Indexed: 11/05/2022] Open
Abstract
Lymphoceles are collections of lymphatic fluid, mainly caused by major surgical approaches. Most lymphoceles are asymptomatic and limited, but some cases may require a medical management. Among the different techniques, transafferent nodal embolization has emerged as a minimally invasive option, with low morbidity and high resolubility, although it is not widespread in the Brazilian scenario. In this study, we report a case of lymphocele drained percutaneously, with maintenance of high output and requiring transafferent nodal embolization.
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Lymphatic Interventions in the Cancer Patient. Curr Oncol Rep 2022; 24:1351-1361. [PMID: 35639331 DOI: 10.1007/s11912-022-01293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The incidence of lymphatic leakage (iatrogenic and non-iatrogenic) is growing in cancer population due to the increased complexity of the surgical procedures and improved overall survival in cancer patients. The purpose of this article is to review the contemporary approach in the field of percutaneous lymphatic embolization in cancer patients with lymphatic leaks. RECENT FINDINGS Since the advent of intranodal lymphangiography in 2011 alongside with the MR and CT lymphangiography, the accuracy of diagnosis of the lymphatic diseases has significantly improved significantly. These advancements have triggered a revival of minimally invasive lymphatic interventions. Lymphatic embolization is expanding from the classic indication, thoracic duct embolization, to other lymphatic disorders (chylous ascites, lymphoceles, liver lymphorrhea, protein-losing enteropathy). The growth of lymphatic research and the standardization of the lymphatic interventions require a multidisciplinary and collaborative approach between physicians and researchers.
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Risk factors of chylous ascites and its relationship with long-term prognosis in laparoscopic D3 lymphadenectomy for right colon cancer. Langenbecks Arch Surg 2022; 407:2453-2462. [PMID: 35589848 DOI: 10.1007/s00423-022-02527-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chylous ascites (CA) after laparoscopic D3 lymphadenectomy for right colon cancer is not rare. However, the risk factors for CA have not been fully explored. Few studies have investigated the effect of CA on long-term prognosis. METHODS The clinical data of patients with right colon cancer who underwent laparoscopic D3 lymphadenectomy in five centers from January 2013 to December 2018 were retrospectively collected. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with CA. Then, the long-term prognosis of patients with and without CA was compared by propensity score matching and Kaplan-Meier survival analysis. RESULTS The incidence of CA was 4.4% (48/1090). Pathological T stage (p = 0.025), dissection along the left side of the superior mesenteric artery (p < 0.001) and the number of retrieved lymph nodes (p < 0.001) were independent risk factors for CA. After propensity score matching, 48 patients in the CA group and 353 patients in the non-CA group were enrolled. Kaplan-Meier survival analysis indicated that CA was not associated with overall survival (p = 0.454) and disease-free survival (p = 0.163). In patients with stage III right colon cancer, there were no significant differences in overall survival (p = 0.501) and disease-free survival (p = 0.254). CONCLUSIONS Pathological T stage, number of retrieved lymph nodes, and left side dissection along the superior mesenteric artery were independent risk factors for CA after laparoscopic D3 lymphadenectomy. CA does not impair the oncological outcomes of patients.
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Liu HT, Liu CA, Wang HK, Liu CS, Shen SH. Minimal invasive treatment for post-liver and renal transplant lymphatic leaks. Clin Transplant 2022; 36:e14691. [PMID: 35485283 DOI: 10.1111/ctr.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/13/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Persistent lymphatic leakage from the surgical drain is a troubling complication occasionally encountered postoperatively. This study investigated lymphatic leaks after renal or liver transplantation, comparing the treatment efficacy of traditional catheter drainage vs. minimally invasive lymphatic interventions. We also discuss access and treatment targets considering the physiology of lymphatic flow. METHODS Between September 2018 and September 2020, 13 patients with lymphatic leakage were treated with minimally invasive lymphatic interventions; 11 had received a renal transplant, and two received a liver transplant. The control group included 10 patients with post-renal transplant lymphatic leakage treated with catheter drainage. The treatment efficacy of catheter drainage, lymphatic interventions, and different targets of embolization were compared. RESULTS The technical success rate for lymphatic intervention was 100%, and the clinical success rate was 92%, with an 82.9% percent reduction in drain volume on the first day after treatment. The duration to reach clinical success was 5.9 days with lymphatic intervention, and 33.9 days with conservative catheter drainage. CONCLUSION Lymphangiography and embolization are minimally invasive and efficient procedures for treating persistent lymphatic leaks after renal or liver transplantation. We suggest prompt diagnosis and embolization at upstream lymphatics to reduce the duration of drain retention, days of hospitalization and associated comorbidities. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hsien-Tzu Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Radiology, Shuang-Ho Hospital, Taiwan, New Taipei City, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Kai Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Su Liu
- National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Transplantation Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University, Taipei, Taiwan
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Sun Y, Deng Y, Lin Y, Lin H, Huang Y, Jiang W, Chi P. Chylous ascites after complete mesocolic excision for right-sided colon cancer with D3 lymphadenectomy: A retrospective cohort-study. Colorectal Dis 2022; 24:461-469. [PMID: 34878703 DOI: 10.1111/codi.16017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/03/2021] [Accepted: 12/01/2021] [Indexed: 02/08/2023]
Abstract
AIM This retrospective study was designed to evaluate risk factors of the occurrence and severity of chylous ascites after complete mesocolic excision (CME) and D3 lymphadenectomy in patients with right-sided colon cancer. METHODS Consecutive patients receiving CME and D3 lymphadenectomy for right-sided colon cancer were included. Risk factors of the occurrence and severity of chylous ascites by using logistic analysis were assessed. A nomogram predicting chylous ascites was constructed. RESULTS Among 661 patients included in the study, postoperative chylous ascites occurred in 48 (7.3%) patients. Logistic regression analysis demonstrated that prognostic nutritional index (PNI ≤ 47, OR = 2.172, p = 0.016), laparoscopic surgery (OR = 2.798, p = 0.034), operating time (>225 min, OR = 2.645, p = 0.002), and apical lymph node (APN) metastasis (OR = 3.698, p = 0.034) were correlated with the occurrence of postoperative chylous ascites. A nomogram predicting postoperative chylous ascites was constructed (C-index 0.701). 31.2% (15/48) of patients with chylous ascites were resolved in more than 7 days. The number of retrieved lymph nodes (OR = 1.074, 95% CI: 1.002-1.152, p = 0.044) and PNI ≤ 47 (OR = 7.890, 95% CI: 1.224-50.869, p = 0.030) were independently predictive of prolonged chylous ascites resolution (≥7 days). CONCLUSIONS In our series, 7.3% of patients developed chylous ascites after right hemicolectomy with CME and D3 lymphadenectomy. Laparoscopic surgery, PNI, operation time, and APN metastasis were independently predictive of postoperative chylous ascites. Lower PNI and more retrieved lymph nodes were correlated with prolonged resolution of chylous ascites.
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Affiliation(s)
- Yanwu Sun
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yu Deng
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yu Lin
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Huiming Lin
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Ying Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Weizhong Jiang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Pan Chi
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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Grenabo Bergdahl A, Månsson M, Holmberg G, Fovaeus M. Robotic retroperitoneal lymph node dissection for testicular cancer at a national referral centre. BJUI COMPASS 2022; 3:363-370. [PMID: 35950045 PMCID: PMC9349583 DOI: 10.1002/bco2.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives We aim to determine if robot‐assisted retroperitoneal lymph node dissection (R‐RPLND) can be performed as a safe option to open RPLND in selected patients with metastatic germ cell cancer. Patients and methods This population‐based prospective study was performed at a one of two national referral centres for RPLND in Sweden. All patients referred during January 2017–March 2021 were screened for possible inclusion. R‐RPLND was performed using the Da Vinci Xi surgical system. Perioperative parameters, postoperative complications (Clavien–Dindo), final pathology, preservation of antegrade ejaculation and relapse rates were evaluated. Classifiers for selecting patients to open versus robotic RPLND were analysed by logistic regression modelling. The median follow‐up was 23 months. Results Of 87 patients referred, 29 were selected for R‐RPLND, 19 in a post‐chemotherapy setting. In median, retroperitoneal tumour diameter was 18 mm, BMI 24 kg/m2, operative time 433 min, estimated blood loss 50 ml and length of stay 3 days. One patient underwent open conversion due to failure to progress. Four patients had Clavien–Dindo grade 3 complications, of which three were chylous‐related. No in‐field recurrences occurred during follow‐up. Conclusion This population‐based study suggests that R‐RPLND can be safely performed in at least one third of patients referred for an RPLND. A relatively high rate of lymph‐leakage may represent a potential drawback. Tumour size may be the most important discriminator when deciding on robotic versus open RPLND. Further studies with longer follow‐up are needed to validate the results.
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Affiliation(s)
- Anna Grenabo Bergdahl
- Department of Urology, Institute of Clinical Science Sahlgrenska Academy at the University of Göteborg Göteborg Sweden
- Department of Urology Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Science Sahlgrenska Academy at the University of Göteborg Göteborg Sweden
| | - Göran Holmberg
- Department of Urology, Institute of Clinical Science Sahlgrenska Academy at the University of Göteborg Göteborg Sweden
- Department of Urology Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Magnus Fovaeus
- Department of Urology, Institute of Clinical Science Sahlgrenska Academy at the University of Göteborg Göteborg Sweden
- Department of Urology Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
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