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Tan X, Luo G, Liao G, Liao H. Postoperative Chylous Ascites in Gynecological Malignancies: Two Case Reports and a Literature Review. Obstet Gynecol Int 2024; 2024:1810634. [PMID: 38957414 PMCID: PMC11219204 DOI: 10.1155/2024/1810634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/04/2023] [Accepted: 06/14/2024] [Indexed: 07/04/2024] Open
Abstract
Aim To explore the potential factors that influence the presentation and recovery of postoperative chylous ascites (CA) in gynecological malignancies. Methods We reported two cases of postoperative CA following gynecological surgery and reviewed the clinical features of 140 patients from 16 relevant papers. Patients' clinicopathological characteristics, surgical approach, and management were summarized. The onset and resolution times of postoperative CA in different groups were analyzed separately. Results The two patients in our report had recovery after conservative treatments. According to the literature review, the median time of onset of postoperative CA was 5 days (range, 0-75 days) after surgery. The median resolution time was 9 days (range, 2-90 days). Among patients, 87.14% of them had lymphadenectomy during gynecological surgeries, while 92.86% of the patients had resolution after conservative treatments. Conclusions Lymphadenectomy during surgery may be relevant to the postoperative CA. Conservative management could be the initial choice for postoperative CA treatment.
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Affiliation(s)
- Xin Tan
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
| | - GuoLin Luo
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
| | - Guangdong Liao
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
| | - Hong Liao
- Obstetrics and Gynecology DepartmentWest China Second University HospitalSichuan University, Chengdu 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and ChildrenSichuan UniversityMinistry of Education, Chengdu 610041, Sichuan, China
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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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Chen L, Lin L, Li L, Xie Z, He H, Lin C, Chen J, Lin A. Lymphatic leakage after pelvic lymphadenectomy for cervical cancer: a retrospective case-control study. BMC Cancer 2021; 21:1242. [PMID: 34794409 PMCID: PMC8603468 DOI: 10.1186/s12885-021-08984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aims to evaluate the clinical features and management of postoperative lymphatic leakage (PLL) in patients with cervical cancer who received pelvic lymphadenectomy. METHODS This retrospective study screened consecutive patients with cervical cancer (stage Ia2-IIb). RESULTS Among 3427 cases screened, 63 patients (1.8%) were diagnosed with PLL, which manifested as persistent abdominal drainage (42/63, 66.7%), chylous ascites (12/63, 19.0%) or vaginal drainage (9/63, 14.3%). Median time from surgery to onset of PLL was 6 days (range, 4-21 days). All cases resolved in a median 10 days (range, 3-56 days) after conservative treatment; although one case experienced recurrence of vaginal drainage after 26 days, this also resolved after conservative therapy. Multivariate analysis showed that two cycles of neoadjuvant chemotherapy (odds ratio [OR], 3.283; 95% confidence interval [95%CI], 1.289-8.360; P = 0.013), a decrease in hemoglobin level of ≥20 and < 30 g/L (OR, 6.175; 95%CI, 1.033-10.919; P = 0.046) or ≥ 30 g/L (OR, 8.467; 95%CI, 1.248-17.426; P = 0.029), and postoperative albumin level ≥ 30 and < 35 g/L (OR, 2.552; 95%CI, 1.112-5.857; P = 0.027) or < 30 g/L (OR, 5.517; 95%CI, 2.047-18.148; P = 0.012) were associated with PLL. CONCLUSION Neoadjuvant chemotherapy, postoperative anemia and postoperative hypoproteinemia are risk factors for PLL.
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Affiliation(s)
- Li Chen
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Liang Lin
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Ling Li
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Zuolian Xie
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Haixin He
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Cuibo Lin
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Jian Chen
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - An Lin
- Department of Gynecology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, Fujian, China.
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La Francesca ME, López C, Kraiñski MS, Hanndorf F, Laporte M. Postoperative chylous leak after a laparoscopic low anterior resection: a case report. J Surg Case Rep 2021; 2021:rjab443. [PMID: 34650793 PMCID: PMC8510641 DOI: 10.1093/jscr/rjab443] [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: 08/08/2021] [Revised: 09/07/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022] Open
Abstract
Chylous leakage is an unusual event after abdominal surgery and even more during colorectal procedures. The management of this complication is already discussed in medical literature. In our case a laparoscopic low anterior resection to an 81-year-old woman with a sigmoid and rectum colon tumor was done. The fourth day after surgery postoperative chylous leakage was diagnosed. It was treated with suspension of oral feeding, total parenteral nutrition and Octreotide with a favorable resolution.
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Affiliation(s)
- Matías Ezequiel La Francesca
- Department of General Surgery, Hospital General De Agudos Parmenio Piñero, Ciudad Autónoma De Buenos Aires, Argentina
| | - Carolina López
- Department of General Surgery, Hospital General De Agudos Parmenio Piñero, Ciudad Autónoma De Buenos Aires, Argentina
| | - María Sol Kraiñski
- Department of General Surgery, Hospital General De Agudos Parmenio Piñero, Ciudad Autónoma De Buenos Aires, Argentina
| | - Fiorela Hanndorf
- Department of General Surgery, Hospital General De Agudos Parmenio Piñero, Ciudad Autónoma De Buenos Aires, Argentina
| | - Mariano Laporte
- Department of General Surgery, Hospital General De Agudos Parmenio Piñero, Ciudad Autónoma De Buenos Aires, Argentina
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Muscaritoli M, Pradelli L. Medium-Chain Triglyceride (MCT) Content of Adult Enteral Tube Feeding Formulas and Clinical Outcomes. A Systematic Review. Front Nutr 2021; 8:697529. [PMID: 34409063 PMCID: PMC8364971 DOI: 10.3389/fnut.2021.697529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023] Open
Abstract
Available data on the effect of lipid composition of enteral formulas on clinical outcomes are controversial. The present systematic review was performed in order to verify whether the presence of specific lipidic substrates, namely medium-chain triglycerides (MCT), in enteral tube feeding formulas is associated to measurable clinical benefits in patients receiving enteral nutrition in different clinical settings, including home enteral nutrition (HEN). The results of this systematic review highlight a lack of robust evidence supporting the use of specific types of lipids in standard or disease-specific formulas. Evidence exists, however, that MCT-containing formulas are safe and well-tolerated. Further, well-designed, adequately powered, randomized controlled trials would be needed in order to assess the superiority of MCT- containing enteral formulas over other standard or disease-specific commercially available enteral products.
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Sun X, Zhou F, Bai X, Yuan Q, Zhang M, Ma L, Jin Y. Application of ultrasound-guided intranodal lymphangiography and embolisation in cancer patients with postoperative lymphatic leakage. World J Surg Oncol 2021; 19:32. [PMID: 33516221 PMCID: PMC7847140 DOI: 10.1186/s12957-021-02144-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic lymphatic leakage is a rare but potentially life-threatening complication. The purpose of this study was to introduce ultrasound-guided intranodal lymphangiography and embolisation techniques for postoperative lymphatic leakage in patients with cancer. METHODS From January 2018 through June 2020, seven cancer patients (three males, four females, aged 59-75 years [mean 67.57 ± 6.11 years]) developed lymphatic leakage after abdominal or pelvic surgery, with drainage volumes ranging from 550 to 1200 mL per day. The procedure and follow-up of ultrasound-guided intranodal lymphangiography and embolisation were recorded. This study retrospectively analysed the technical success rate, operative time, length of hospital stay, clinical efficacy, and complications. RESULTS The operation was technically successful in all patients. Angiography revealed leakage, and embolisation was performed in all seven patients (7/7, 100%). The operative time of angiography and embolisation was 41 to 68 min, with an average time of 53.29 ± 10.27 min. The mean length of stay was 3.51 ± 1.13 days. Lymph node embolisation was clinically successful in five patients (5/7, 71.43%), who had a significant reduction in or disappearance of chylous ascites. The other two patients received surgical treatment 2 weeks later due to poor results after embolisation. All patients were followed for 2 weeks. No serious complications or only minor complications were found in all the patients. CONCLUSIONS Ultrasound-guided intranodal lymphangiography and embolisation were well tolerated by the patients, who experienced a low incidence of complications. Early intervention is recommended for cancer patients with postoperative lymphatic leakage.
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Affiliation(s)
- Xingwei Sun
- Department of Intervention, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, 215004, People's Republic of China
| | - Feng Zhou
- Department of Ultrasound Medicine, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, 215000, People's Republic of China
| | - Xuming Bai
- Department of Intervention, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, 215004, People's Republic of China
| | - Qiang Yuan
- Department of Intervention, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, 215004, People's Republic of China
| | - Mingqing Zhang
- Department of Intervention, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, 215004, People's Republic of China
| | - Liang Ma
- Department of Oncology, The Fourth Affiliated Hospital of Nantong University, First People's Hospital of Yancheng, Yancheng, 224001, Jiangsu, People's Republic of China.
| | - Yong Jin
- Department of Intervention, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, 215004, People's Republic of China.
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Fernandes V, Queirós J, Soares C. Chylous ascites: Case report of a rare presentation of blunt abdominal trauma. Int J Surg Case Rep 2020; 77:799-802. [PMID: 33395899 PMCID: PMC7724093 DOI: 10.1016/j.ijscr.2020.11.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Chylous ascites is the accumulation of a milk-like peritoneal fluid rich in triglycerides, due to the presence of intestinal lymph in the abdominal cavity. The most common causes of chylous acites in adults are abdominal malignancy and cirrhosis. Very few cases of chylous ascites associated to blunt abdominal trauma have been published in the literature. CLINICAL CASE A 27-year-old, female patient was admitted to the emergency department (ED) with abdominal pain due to a deceleration-type traffic accident. During surveillance the patient presented a progressive decrease in hemoglobin levels and an increase in free intra-abdominal fluid detected on computed tomography scan. The patient underwent an exploratory laparoscopy and a milky-looking peritoneal fluid was identified. The diagnosis of chylous ascites was confirmed by the determination of increased triglyceride levels in the peritoneal fluid. A low-fat diet, with a restriction of long-chain triglycerides, was started in the post-operative period and the patient presented a progressive decrease in abdominal drainage. The patient had a favorable clinical and analytical evolution and was discharged on the fifth post-operative day. DISCUSSION Chylous ascites is an uncommon finding in trauma. Although surgery may be indicated in selected patients, conservative treatment can be effective in most patients, with or without abdominal drainage. A high-protein and low-fat diet, with medium-chain triglycerides, is the indicated dietary regimen to decrease the amount of lymphatic fluid produced. CONCLUSION Chylous ascites, although rare in trauma patients must be considered in the diferential diagnosis of free peritoneal fluid. Conservative treatment should be considered in the majority of cases reserving invasive treatments for specific situations.
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Affiliation(s)
- Vânia Fernandes
- General Surgery Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.
| | - Jacinta Queirós
- General Surgery Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Carlos Soares
- General Surgery Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
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Zheng J, Chen YY, Zhang CY, Zhang WQ, Rao ZY. The retrospective research of enteral nutrition with medium-chain triglyceride and total parenteral nutrition support of postoperative chylothorax in adults. SAGE Open Med 2020; 8:2050312120938221. [PMID: 32655864 PMCID: PMC7331756 DOI: 10.1177/2050312120938221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/08/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Chylothorax is caused by thoracic lymphatic system injuries that leads to the lymph extravasating into the thoracic cavity. There are few reports comparing the therapeutic effects of enteral nutrition with medium-chain triglyceride and total parenteral nutrition, and the results are inconsistent. Our study aimed to research the optimum nutrition support method for chylothorax. Study design: We retrospectively reviewed 35 chylothorax patients after heart and chest surgery from 2014 to 2018, at West China Hospital of Sichuan University, among them there were 27 post-heart surgery patients. We analyzed the therapeutic effects and costs of enteral nutrition with medium-chain triglyceride (E group) and total parenteral nutrition (T group) for chylothorax. Results: The results were similar in patients with all surgeries and patients with only post heart surgery. The total cost during hospitalization in E group was higher than T group (P < 0.01), whereas the nutrition support cost was lower (P < 0.001). The length of hospital stay was longer in E group than T group (P > 0.05). Time from admission to surgery was shorter and from surgery to chylothorax diagnosis was longer in E group compared with T group. Time to resolution and removal of drainage was shorter in E group than T group but the differences were not significant. Conclusion: The therapeutic effects in enteral nutrition with medium-chain triglyceride and total parenteral nutrition had no obvious differences. Moreover, enteral nutrition with medium-chain triglyceride is safer and more economical. Therefore, we suggest that enteral nutrition with medium-chain triglyceride could be the first choice to treat postoperative chylothorax when the gastrointestinal tract function is allowed, and this result could be considered for postoperative chylous ascites.
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Affiliation(s)
- Jie Zheng
- Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, China
| | - Ying-Yi Chen
- Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, China
| | - Chun-Ying Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Wen-Qian Zhang
- Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, China
| | - Zhi-Yong Rao
- Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, China
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Du N, Rao Z, Che G, Huang X, Ji Y, Wang M, Yang M, Liu L. [What is Result: Short-term Medium Chain Triglyceride Diet Effective on
Postoperative Outcome in Lung Cancer Surgery? A Prospective Randomized Study]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:821-826. [PMID: 27978867 PMCID: PMC5973457 DOI: 10.3779/j.issn.1009-3419.2016.12.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
背景与目的 中链甘油三酯(medium chain triglyceride, MCT)饮食有助于外科手术患者快速康复,本研究将短期MCT食谱应用于肺癌患者术后早期饮食,探讨肺癌患者术后应用MCT的临床效果。 方法 2015年12月-2016年3月四川大学华西胸外科单个医疗组肺癌切除术患者纳入研究患者117例,随机分为MCT组(62例)和常规饮食组(routine diet group, RDG)(55例)。分析两组患者术后白蛋白、肛门排气时间、胸腔闭式引流量及胸腔闭式引流管留置时间、术后住院日、住院费用。 结果 MCT组患者术后肛门排气时间[(27.87±14.38) h]短于RDG组[(45.18±8.62) h](P < 0.001);术后胸腔引流管留置时间在MCT组[(75.40±48.41) h]少于RDG组[(110.64±94.19) h](P=0.025);术后胸腔引流量在MCT[395mL]组少于RDG组[590mL](P=0.027)。术后住院日在MCT组[(5.26±2.96) d)]短于RDG组[(6.73±3.99) d](P=0.030)。血浆白蛋白术后MCT组[(37.26±2.70) g/L]高于RDG组[(35.92±3.12) g/L](P=0.023)。 结论 肺癌患者术后短期应用MCT饮食有助于改善胃肠功能快速恢复,且缩短术后住院时间。
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Affiliation(s)
- Na Du
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhiyong Rao
- Department of Nutritional Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xuemei Huang
- Department of Nutritional Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yanli Ji
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mingming Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mei Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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