Lymphatic leakage after pelvic lymphadenectomy for cervical cancer: a retrospective case-control study

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.

Early drainage removal in the management of lymphatic leakage after robotic pelvic lymph node dissection

“…Thus, clinical management modalities have been mainly focused on conservative treatment and watchful waiting [ 19 ] . The traditional way of dealing with a persistent high volume (more than 50 mL/day) drainage was to keep the drainage tube till the drainage volume decreased to lower than 50 mL/day [ 20 ] . However, it is unclear if this is the best way to manage the high‐volume lymphatic leakage by leaving the drain for an extended period, or on the contrary, the lower intra‐abdominal pressure produced by the gravity drain may have potentially perpetuated an otherwise small lymph leak, leading to a persistent lymphatic leakage [ 7 ] .…”

The application of a medium-chain fatty diet and enteral nutrition in post-operative chylous leakage: analysis of 63 patients

“…In the present study, the duration median was 8, 3, or 7 days in hepatobiliary surgery, gastrointestinal surgery, and urological surgery. For gynecological surgery patients with chylous leakage cured by TPN alone, the median was 15 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16) days (60). The median for days of drainage was 3 (1-21) days (3 cases discharged with a drainage tube on day 1 of intervention and 1 on day 2) in the present study under a similar condition.…”

“…We found no relevant reports on the analysis of factors associated with effective postintervention outcomes. However, it was reported that lower hemoglobin is associated with a higher incidence rate of CL ( 14 ), which may predict that lower hemoglobin probably influences the effects of oral nutritional interventions. Our analysis of post-operative hemoglobin on intervention outcomes may inform future studies.…”

“…CL may occur in 1–16% of patients after pancreatectomy ( 10 , 11 ). CL occurs in ~3.8%−5.1% of nephrectomy ( 12 , 13 ) and approximately 0.3–7.4% in gynecology ( 14 , 15 ). Patients with post-operative CL are often in a state of high energy expenditure and protein requirements due to traumatic stress.…”