A rare complication of D3 dissection for gastric carcinoma: chyloperitoneum

Chylous ascites as a complication of laparoscopic colorectal surgery

“…In the 137 patients in the present study, there was an incidence rate of 6.5% for chylous ascites after laparoscopic colorectal surgery. This is higher than previously reported results after open colorectal surgery or other abdominal surgery . The main cause of postoperative chylous ascites is considered to be intraoperative injury of the main lymphatic vessels .…”

Postoperative chylous ascites after colorectal cancer surgery

“…These articles suggest that the incidence of chylous ascites following gastric cancer with D3 dissection is 3-5%. Hence, the frequency of chylous ascites following colorectal cancer surgery with D3 dissection is lower than that in gastric cases, and also seems to be lower than the 6.6% reported by Neyer et al after surgery for urological cancer with retroperitoneal lymph node dissection [15,16,[18][19][20][21]. The degree of chyle leakage after colorectal surgery may be milder than that after lung or upper abdominal surgery because peripheral lymph systems tend to be injured in colorectal surgery, whereas central lymph systems (thoracic duct or cisterna chyli) may be injured in lung or upper abdominal surgery [6].…”

“…Yol et al reported one (3.9%) case of chylous ascites among 34 patients who underwent gastric cancer surgery. In the JCOG 9501 study, lymphorrhea was observed in 10 of 260 D3 surgery cases (3.8%) [16], while Maeta et al [17] reported four (5.6%) cases of lymphorrhea among 70 patients who underwent D3 lymphadenectomy. These articles suggest that the incidence of chylous ascites following gastric cancer with D3 dissection is 3-5%.…”

“…None of our patients required surgery, but it should be considered if the patient is unresponsive to conservative treatment. The treatment strategy is almost the same as that for other organs; however, in patients with upper abdominal cancer or lung cancer, surgical exploration and direct ligation of the source of chylous leakage tend to be performed when conservative therapy is not effective because the amount of chylous ascites is greater and it is easier to detect the source of chylous leakage than after surgery for colon cancer [1,5,13,15,16,19,23].…”

Management of postoperative complications of lymphadenectomy

“…The major causes are traumatic lesions, surgical procedures or malignant obstructions. Other even more rare underlying conditions have been described as leading to chyloperitoneum (41). It is a very rare post-operative complication and its incidence undetermined.…”