Chylous Ascites and Lymphoceles: Evaluation and Interventions

Santos, Ernesto; Moussa, Amgad M.

doi:10.1055/s-0040-1713445

Cited by 17 publications

(22 citation statements)

References 86 publications

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“…The incidence of postoperative lymphatic leakage during our study period was 14.4% after renal transplant, which is well within the .6–33.9% range of several transplant centers 1–4 . On the other hand, the incidence of lymphatic leakage after a liver transplant was 11.7%, which is higher than the reported range of .6–4.7% 5–7 .…”

Section: Discussionsupporting

confidence: 77%

“…Other studies showed that embolization also offers the advantage of reducing the need for repeat treatments. 3 A systemic review comprising 52 retrospective case series which used traditional methods for treating lymphoceles after renal transplant reported a recurrence rate of 31% after sclerotherapy and 50% with catheter drainage. 26 We did not experience any leak recurrence in our study patients that achieved initial clinical success.…”

Section: Embolizationmentioning

confidence: 99%

“…Apart from the well‐known complications related to the surgical drain itself such as pressure necrosis of the adjacent tissue, hemorrhage, local inflammation, and serving as a focus of infection, 2 many comorbidities are related to the dysfunction of the lymphatic system. Persistent high volume fluid loss from lymphatic leaks can result in dehydration, nutritional deficiency, or immunologic dysfunction, thereby increasing the risk of infection, morbidity or even mortality 3–5 …”

Section: Introductionmentioning

confidence: 99%

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Minimal invasive treatment for post‐liver and renal transplant lymphatic leaks

Liu

Wang

et al. 2022

Clinical Transplantation

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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 postrenal 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% 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.

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Section: Discussionsupporting

confidence: 77%

Section: Embolizationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Minimal invasive treatment for post‐liver and renal transplant lymphatic leaks

Liu

Wang

et al. 2022

Clinical Transplantation

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“…The mainstay of the treatment of postoperative chylous ascites is conservative therapy [24]. Surgical intervention is only indicated for refractory cases.…”

Section: Discussionmentioning

confidence: 99%

“…We developed a predictive nomogram for the individualized probability of chylous ascites following right hemicolectomy with The mainstay of the treatment of postoperative chylous ascites is conservative therapy [24]. Surgical intervention is only indicated for refractory cases.…”

Section: Discussionmentioning

confidence: 99%

Chylous ascites after complete mesocolic excision for right‐sided colon cancer with D3 lymphadenectomy: A retrospective cohort‐study

et al. 2021

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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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Robotic retroperitoneal lymph node dissection for testicular cancer at a national referral centre

et al. 2022

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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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Chylous Ascites and Lymphoceles: Evaluation and Interventions

Cited by 17 publications

References 86 publications

Minimal invasive treatment for post‐liver and renal transplant lymphatic leaks

Minimal invasive treatment for post‐liver and renal transplant lymphatic leaks

Chylous ascites after complete mesocolic excision for right‐sided colon cancer with D3 lymphadenectomy: A retrospective cohort‐study

Robotic retroperitoneal lymph node dissection for testicular cancer at a national referral centre

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