Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Chylous Ascites After Gastric Cancer Surgery: Risk Factors and Treatment Results

  • Sung Hyun Park (Department of Surgery, Yonsei University College of Medicine) ;
  • Ki-Yoon Kim (Department of Surgery, Yonsei University College of Medicine) ;
  • Minah Cho (Department of Surgery, Yonsei University College of Medicine) ;
  • Hyoung-Il Kim (Department of Surgery, Yonsei University College of Medicine) ;
  • Woo Jin Hyung (Department of Surgery, Yonsei University College of Medicine) ;
  • Yoo Min Kim (Department of Surgery, Yonsei University College of Medicine)
  • Received : 2022.08.13
  • Accepted : 2022.10.28
  • Published : 2023.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Although chylous ascites is a frequent complication of radical gastrectomy for gastric cancer, proper diagnostic criteria and optimal treatment strategies have not been established. This study aimed to identify the clinical features of chylous ascites and evaluate the treatment outcomes. Materials and Methods: We retrospectively analyzed the data of patients who underwent radical gastrectomy between 2013 and 2019. Diagnosis was made when milky fluid or elevated triglyceride levels (≥100 mg/dL) appeared in the drains without a preceding infection. The clinical features, risk factors, and treatment outcomes were assessed according to the initial treatment modalities for fasting and non-fasting groups. Results: Among the 7,388 patients who underwent radical gastrectomy for gastric cancer, 156 (2.1%) experienced chylous ascites. The median length of hospital stay was longer in patients with chylous ascites than in those without (median [interquartile range]: 8.0 [6.0-12.0] vs. 6.0 [5.0-8.0], P<0.001). Low body mass index (adjusted odds ratio [aOR]=0.9; P<0.001), advanced gastric cancer (aOR=1.51, P=0.024), open surgery (reference: laparoscopic surgery; aOR=1.87, P=0.003), and extent of surgical resection (reference: subtotal gastrectomy, total gastrectomy, aOR=1.5, P=0.029; proximal gastrectomy, aOR=2.93, P=0.002) were associated with the occurrence of chylous ascites. The fasting group (n=12) was hospitalized for a longer period than the non-fasting group (n=144) (15.0 [12.5-19.5] vs. 8.0 [6.0-10.0], P<0.001). There was no difference in grade III complication rate (16.7% vs. 4.2%, P=0.117) or readmission rate (16.7% vs. 11.1%, P=0.632) between the groups. Conclusions: A fat-controlled diet and medication without fasting provided adequate initial treatment for chylous ascites after radical gastrectomy for gastric cancer.

Keywords

Acknowledgement

We acknowledge the assistance of Bioscience Writers, LLC (Houston, TX, USA) with language editing.

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-249.  https://doi.org/10.3322/caac.21660
  2. Guideline Committee of the Korean Gastric Cancer Association (KGCA), Development Working Group & Review Panel. Korean Practice Guideline for Gastric Cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer 2019;19:1-48.  https://doi.org/10.5230/jgc.2019.19.e8
  3. Mocellin S. The effect of lymph node dissection on the survival of patients with operable gastric carcinoma. JAMA Oncol 2016;2:1363-1364.  https://doi.org/10.1001/jamaoncol.2016.2044
  4. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010;11:439-449.  https://doi.org/10.1016/S1470-2045(10)70070-X
  5. Cardenas A, Chopra S. Chylous ascites. Am J Gastroenterol 2002;97:1896-1900.  https://doi.org/10.1016/S0002-9270(02)04268-5
  6. Kaas R, Rustman LD, Zoetmulder FA. Chylous ascites after oncological abdominal surgery: incidence and treatment. Eur J Surg Oncol 2001;27:187-189.  https://doi.org/10.1053/ejso.2000.1088
  7. Lizaola B, Bonder A, Trivedi HD, Tapper EB, Cardenas A. Review article: the diagnostic approach and current management of chylous ascites. Aliment Pharmacol Ther 2017;46:816-824.  https://doi.org/10.1111/apt.14284
  8. Baek SJ, Kim SH, Kwak JM, Kim J. Incidence and risk factors of chylous ascites after colorectal cancer surgery. Am J Surg 2013;206:555-559.  https://doi.org/10.1016/j.amjsurg.2013.01.033
  9. Nishigori H, Ito M, Nishizawa Y, Koyama A, Koda T, Nakajima K, et al. Postoperative chylous ascites after colorectal cancer surgery. Surg Today 2012;42:724-728.  https://doi.org/10.1007/s00595-012-0132-x
  10. Matsuda T, Fujita H, Kunimoto Y, Kimura T, Ogino K. Chylous ascites as a complication of laparoscopic colorectal surgery. Asian J Endosc Surg 2013;6:279-284.  https://doi.org/10.1111/ases.12057
  11. Lee SY, Kim CH, Kim YJ, Kim HR. Chylous ascites after colorectal cancer surgery: risk factors and impact on short-term and long-term outcomes. Langenbecks Arch Surg 2016;401:1171-1177.  https://doi.org/10.1007/s00423-016-1500-6
  12. Evans JG, Spiess PE, Kamat AM, Wood CG, Hernandez M, Pettaway CA, et al. Chylous ascites after post-chemotherapy retroperitoneal lymph node dissection: review of the M. D. Anderson experience. J Urol 2006;176:1463-1467.  https://doi.org/10.1016/j.juro.2006.06.016
  13. Omloo JM, Lagarde SM, Vrouenraets BC, Busch OR, van Lanschot JJ. Compartimentalization for chylothorax originating from the abdomen after extended esophagectomy. Report of two cases and review of the literature. Dig Surg 2006;23:86-92.  https://doi.org/10.1159/000093499
  14. Tulunay G, Ureyen I, Turan T, Karalok A, Kavak D, Ozgul N, et al. Chylous ascites: analysis of 24 patients. Gynecol Oncol 2012;127:191-197.  https://doi.org/10.1016/j.ygyno.2012.06.023
  15. Sakran N, Parmar C, Ahmed S, Singhal R, Madhok B, Stier C, et al. Chyloperitoneum and chylothorax following bariatric surgery: a systematic review. Obes Surg 2022;32:2764-2771.  https://doi.org/10.1007/s11695-022-06136-3
  16. Pan W, Yang C, Cai SY, Chen ZM, Cheng NS, Li FY, et al. Incidence and risk factors of chylous ascites after pancreatic resection. Int J Clin Exp Med 2015;8:4494-4500. 
  17. Li YZ, Yang J, Hu S, Zhan H. Progress in diagnosis and treatment of chylous leakage following pancreatic resection. Zhonghua Wai Ke Za Zhi 2021;59:316-320. 
  18. Du JJ, Li JP, Ding ZR, Zheng JY, Ji G, Gao ZQ, et al. Management of chylous leakage after radical operation of gastric cancer. Zhonghua Yi Xue Za Zhi 2007;87:1414-1416.
  19. Griniatsos J, Dimitriou N, Kyriaki D, Velidaki A, Sougioultzis S, Pappas P. Chylorrhea complicating D2+a gastrectomy: review of the literature and clarification of terminology apropos one case. Chin Med J (Engl) 2010;123:2279-2283. 
  20. Kakinuma D, Kanazawa Y, Matsuno K, Masuda Y, Ando F, Hagiwara N, et al. Ligation and fibrin glue spraying for intractable chylous ascites after radical gastrectomy for gastric cancer: case report and literature review. J Nippon Med Sch 2021;88:242-247.  https://doi.org/10.1272/jnms.JNMS.2021_88-310
  21. Lu J, Wei ZQ, Huang CM, Zheng CH, Li P, Xie JW, et al. Small-volume chylous ascites after laparoscopic radical gastrectomy for gastric cancer: results from a large population-based sample. World J Gastroenterol 2015;21:2425-2432.  https://doi.org/10.3748/wjg.v21.i8.2425
  22. Rajasekar A, Ravi NR, Diggory RT. Chylous ascites: a rare complication of radical gastrectomy. Int J Clin Pract 2000;54:201-203.  https://doi.org/10.1111/j.1742-1241.2000.tb11883.x
  23. Yamada T, Jin Y, Hasuo K, Maezawa Y, Kumazu Y, Rino Y, et al. Chylorrhea following laparoscopy assisted distal gastrectomy with D1+ dissection for early gastric cancer: a case report. Int J Surg Case Rep 2013;4:1173-1175.  https://doi.org/10.1016/j.ijscr.2013.10.006
  24. Yol S, Bostanci EB, Ozogul Y, Ulas M, Akoglu M. A rare complication of D3 dissection for gastric carcinoma: chyloperitoneum. Gastric Cancer 2005;8:35-38.  https://doi.org/10.1007/s10120-004-0312-5
  25. Al-Busafi SA, Ghali P, Deschenes M, Wong P. Chylous ascites: evaluation and management. ISRN Hematol 2014;2014:240473. 
  26. Noji T, Nakamura T, Ambo Y, Suzuki O, Nakamura F, Kishida A, et al. Early enteral feeding after distal pancreatectomy may contribute to chyle leak. Pancreas 2012;41:331-333.  https://doi.org/10.1097/MPA.0b013e31822891f8
  27. Berzigotti A, Magalotti D, Cocci C, Angeloni L, Pironi L, Zoli M. Octreotide in the outpatient therapy of cirrhotic chylous ascites: a case report. Dig Liver Dis 2006;38:138-142.  https://doi.org/10.1016/j.dld.2005.05.013
  28. Zhou DX, Zhou HB, Wang Q, Zou SS, Wang H, Hu HP. The effectiveness of the treatment of octreotide on chylous ascites after liver cirrhosis. Dig Dis Sci 2009;54:1783-1788.  https://doi.org/10.1007/s10620-008-0566-6
  29. Ilhan E, Demir U, Alemdar A, Ureyen O, Eryavuz Y, Mihmanli M. Management of high-output chylous ascites after D2-lymphadenectomy in patients with gastric cancer: a multi-center study. J Gastrointest Oncol 2016;7:420-425.  https://doi.org/10.21037/jgo.2016.02.03
  30. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae