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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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Imai H, Saijo K, Takenaga N, Komine K, Ouchi K, Kasahara Y, Ishikawa S, Sasaki K, Yoshida Y, Shirota H, Takahashi M, Ishioka C. Chylous Ascites Associated with Advanced Pancreatic Cancer That Improved with Appropriate Treatment: A Case Report. Curr Oncol 2024; 31:1477-1482. [PMID: 38534945 PMCID: PMC10969774 DOI: 10.3390/curroncol31030112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 05/26/2024] Open
Abstract
Chylous ascites is a rare form of ascites with high triglyceride content arising from the thoracoabdominal lymph nodes in the peritoneal cavity due to various benign or malignant etiologies, including pancreatic cancer. During cancer chemotherapy, the accumulation of ascites can lead to the deterioration of the patient's general condition, making chemotherapy administration difficult, and resulting in a poor prognosis. We encountered a rare case of chylous ascites complicated by advanced pancreatic cancer. The patient presented with a discrepancy between the shrinkage of the pancreatic cancer and the accumulation of ascites. Therefore, we were able to promptly diagnose chylous ascites by performing biochemical tests. The patient was treated with octreotide, reportedly effective in treating chylous ascites, which rapidly improved the chylous ascites and general condition of the patient, allowing the patient to continue chemotherapy for pancreatic cancer. Therefore, physicians should consider the possibility of chylous ascites when clinically unexplained ascites are observed in patients with advanced cancer. The investigation and treatment of chylous ascites should be initiated as soon as possible.
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Affiliation(s)
- Hiroo Imai
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Ken Saijo
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Noriko Takenaga
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Keigo Komine
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Kota Ouchi
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Yuki Kasahara
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Shiori Ishikawa
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Keiju Sasaki
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Yuya Yoshida
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Hidekazu Shirota
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Masanobu Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Chikashi Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Sendai 980-8547, Japan; (H.I.); (K.S.); (K.K.); (K.O.); (Y.K.); (S.I.); (K.S.); (Y.Y.); (H.S.); (M.T.)
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
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Jaleel J, Nasurudeen S, Babu AS, Gupta P, Khangembam BC, Patel C, Kumar R. Utility of 99mTc-Sulfur Colloid Lymphoscintigraphy and SPECT/CT in Chylothorax and Chylous Ascites. Nucl Med Mol Imaging 2023; 57:265-274. [PMID: 37982099 PMCID: PMC10654269 DOI: 10.1007/s13139-023-00813-6] [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: 01/14/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 11/21/2023] Open
Abstract
Purpose To assess the diagnostic efficacy of 99mTc-sulfur colloid lymphoscintigraphy in chylothorax and chylous ascites, and the utility of single-photon emission computed tomography-computed tomography (SPECT/CT) in localizing the sites of leaks. Methods Data from patients who underwent lymphoscintigraphy for clinical suspicion of chylothorax or chylous ascites were retrospectively analyzed. Biochemical fluid analysis was taken as the reference standard. Pleural fluid triglyceride level > 110 mg/dL (with pleural fluid/serum ratio > 1) and a cholesterol level < 200 mg/dL (with pleural fluid/serum ratio < 1) were considered confirmatory for chylothorax. Ascitic fluid triglyceride level > 200 mg/dL with a low cholesterol level (ascites fluid/serum ratio < 1) was considered confirmatory for chylous ascites. Results 26 patients (15 males, 57.7%) aged 9 months to 68 years were enrolled in the study. Based on the reference standard, 17 had chylothorax or chylous ascites (9 with surgical history). Lymphoscintigraphy was positive in 16 (with 1 false positive) and negative in 10 (with 2 false negatives). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of lymphoscintigraphy were 88.2% (63.6-98.5%), 88.9% (51.8-99.7%), 80.0% (51.6-93.8%), 93.8% (70.1-99.0%), and 88.5% (69.9-97.6%), respectively. SPECT/CT could localize sites of leaks in 61.5% (8/13) with a localization rate of 77.8% (7/9) and 25.0% (1/4) in patients with surgical and nonsurgical causes, respectively. Conclusion 99mTc-sulfur colloid lymphoscintigraphy is a highly efficacious noninvasive modality to diagnose chylothorax or chylous ascites with a high positive predictive value. SPECT/CT could localize the sites of leaks more frequently in patients with surgical causes.
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Affiliation(s)
- Jasim Jaleel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anushna Sunila Babu
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Gupta
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Wang K, Xiao J, Li L, Li X, Yang Y, Liu Z, Jiang J. The application of a medium-chain fatty diet and enteral nutrition in post-operative chylous leakage: analysis of 63 patients. Front Nutr 2023; 10:1128864. [PMID: 37545584 PMCID: PMC10399236 DOI: 10.3389/fnut.2023.1128864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background Post-operative chylous leakage (CL) is the pathologic leakage of chylomicron fluid after surgery. This retrospective study was performed to evaluate a uniform oral nutrition management strategy on the post-operative CL. Methods We retrospectively reviewed patients who developed post-operative CL and received consultation from a clinical nutritionist in seven departments of the Second Affiliated Hospital of Dalian Medical University from May 2020 to April 2022. We designed the oral nutrition intervention program which mainly standardized the type and amount of foods contained in the medium-chain triglyceride (MCT) diet. The influencing factors of curative efficacy were analyzed. Finally, binary logistic regression analysis was conducted to observe the relationship between curative efficacy and potentially predictive variables, including post-operative albumin, post-operative hemoglobin, surgical procedure, and drainage volume at consultation. Results Sixty-three patients with post-operative CL were included in this analysis. Of this number, 58 patients were cured successfully without other treatments. Three patients had a significantly prolonged recovery period, and the remaining two cases were treated by reoperation therapy. The leakage volume at the initiation of enteral intervention had no statistically significant difference in seven surgical departments and surgical sites (left, right, median, and bilateral). The length of stay (LOS) of patients with CL after the intervention was not significantly increased in cardiac, hepatobiliary, gastrointestinal, and urological surgeries. Patients with CL had longer LOS than those without CL in gynecology (P=0.044) and thyroid surgery departments (P=0.008). Each unit increase in post-operative hemoglobin would increase the probability of an effective outcome by 8%, which was statistically significant (P = 0.037). Conclusion In treating patients with post-operative CL, we recommend the MCT diet and EN as the first option, rather than fasting, parenteral nutrition (PN), or octreotide.
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Affiliation(s)
- Ke Wang
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jiaming Xiao
- Department of Nutrition and Food Hygiene, School of Public Health, Dalian Medical University, Dalian, Liaoning, China
| | - Li Li
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xu Li
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yilun Yang
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zhiyu Liu
- Department of Urological Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jing Jiang
- Department of Nursing, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Lee K, Chang SJ, Won JH, Kwon Y, Kim SH, Kim JE, Kim J. Intranodal Lymphangiography and Embolization for the Treatment of Early Postoperative Lymphatic Leaks after Pelvic Surgery. J Vasc Interv Radiol 2022; 34:591-599.e1. [PMID: 36526076 DOI: 10.1016/j.jvir.2022.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess outcome and predictors of outcome after lymphatic embolization (LE) for early postoperative lymphatic leak after pelvic surgery. MATERIAL AND METHODS Lymphangiography (LG) procedures performed between May 2015 and February 2020 for postoperative intraperitoneal lymphatic leaks after pelvic surgery were reviewed. Treatment indication was lymphatic drainage of >500 mL/d persisting for >1 week. LE was performed by injecting glue into the iliac lymph node. Fisher exact and Wilcoxon rank-sum tests were used for comparative analysis, and logistic regression was used to assess predictors of outcome. RESULTS LG was performed in 71 patients. A leak was demonstrated in 69 patients who underwent LE. The mean drainage was 1,329 mL/d ± 773. Catheters were removed in 49 (69.0%) patients after 1 procedure and in 69 (97.2%) patients after a mean of 1.3 procedures. The mean drainage at the time of catheter removal was 157 mL/d ± 100. Failure occurred in 12 (16.9%) cases, including 2 (2.8%) cases of unsuccessful catheter removal and 10 (14.1%) cases of catheter reinsertion owing to recurrent ascites (n = 3) and lymphoceles (n = 7). Older age and drainage of >1,500 mL/d were associated with failure (P = .004). Drainage of >1,500 mL/d was associated with a post-LE catheter dwell time of longer than 1 week (P = .024). Minor adverse events were noted in 4 (5.6%) patients who presented with transient leg swelling. CONCLUSIONS LE was effective for treating pelvic surgery-related lymphatic leaks. Reintervention may be required. Drainage of >1,500 mL/d was associated with clinical failure and a post-LE catheter dwell time of longer than 1 week.
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Affiliation(s)
- Kyungmin Lee
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Je Hwan Won
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yohan Kwon
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seong Ho Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Eun Kim
- Department of Radiology, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jinoo Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
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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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Rodriguez J, Sanabria D, Muñoz M, Rivero O, Pareja R. Management of refractory chylous ascites: a challenge after lymphadenectomy. Int J Gynecol Cancer 2022; 32:1076-1079. [PMID: 35914797 DOI: 10.1136/ijgc-2022-003742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Juliana Rodriguez
- Department of Gynecologic Oncology- GICE Group, Instituto Nacional de Cancerología, Bogotá, Colombia .,Department of Gynecology and Obstetrics, section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Daniel Sanabria
- Department of Gynecology and Obstetrics, section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Department of Gynecologic Oncology, Clinica los Nogales, Bogotá, Colombia
| | - Mario Muñoz
- Department of Surgery, Las Americas Company Group, Medellin, Colombia
| | - Oscar Rivero
- Department of Radiology, Fundacion Santa Fe de Bogotá, Bogota, Colombia
| | - Rene Pareja
- Gynecologic Oncology, Clinica ASTORGA, Medellín, Colombia.,Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
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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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Zheng HD, Liu YR, Chen ZZ, Sun YF, Xu CH, Xu JH. Nomogram for predicting chylous ascites after right colectomy. World J Gastrointest Surg 2021; 13:1361-1371. [PMID: 34950426 PMCID: PMC8649560 DOI: 10.4240/wjgs.v13.i11.1361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/01/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chylous ascites following right colectomy has a high incidence which is a critical challenge. At present, there are few studies on the factors affecting chylous ascites after right colectomy and especially after D3 Lymphadenectomy. A predictive model for chylous ascites has not yet been established. Therefore, we created the first nomogram to predict the incidence of chylous ascites after right hemicolectomy.
AIM To analyze the risk factors for chylous ascites after right colectomy and establish a nomogram to predict the incidence of chylous ascites.
METHODS We retrospectively collected patients who underwent right hemicolectomy between January 2012 and May 2021 and were pathologically diagnosed with cancer. Multivariate logistic regression was used to analyze the influencing factors of chylous ascites and a nomogram was established. The predictive ability was assessed by the area under the receiver operating characteristic (ROC) curve.
RESULTS Operative time, the type of operation (standard or extended), the number of lymph nodes retrieved, and somatostatin administration were considered important risk factors. Multivariate logistic regression and nomograms can be used to accurately predict whether chylous ascites occurs. The area under the ROC curve of the model is 0.770. The C-statistic of this model is 0.770 which indicates that it has a relatively moderate ability to predict the risk of chylous ascites.
CONCLUSION We found a novel set of risk factors, created a nomogram, and validated it. The nomogram had a relatively accurate forecasting ability for chylous ascites after right hemicolectomy and can be used as a reference for risk assessment of chylous ascites and whether to prevent it after surgery.
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Affiliation(s)
- Hui-Da Zheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Yu-Rong Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Zhen-Ze Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Ya-Feng Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Chun-Hao Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Jian-Hua Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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