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Erschienen in: Langenbeck's Archives of Surgery 8/2016

24.08.2016 | ORIGINAL ARTICLE

Chylous ascites after colorectal cancer surgery: risk factors and impact on short-term and long-term outcomes

verfasst von: Soo Young Lee, Chang Hyun Kim, Young Jin Kim, Hyeong Rok Kim

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 8/2016

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Abstract

Purpose

Data on the incidence, risk factors, and oncologic impact of chylous ascites after colorectal cancer surgery are scarce. In this study, we aimed to assess the risk factors and the short-term and long-term impact of chylous ascites after colorectal cancer surgery.

Methods

We retrospectively examined 2917 primary colorectal cancer patients who underwent surgical resection between January 2008 and December 2013. The short-term and long-term outcomes were compared between patients with and those without postoperative chylous ascites, and the risk factors for chylous ascites were analyzed.

Results

Chylous ascites developed in 138 (4.7 %) patients. A shorter operative time (odds ratio [OR] 0.992, 95 % confidence interval [CI] 0.988–0.996) and the number of retrieved lymph nodes (OR 1.015, 95 % CI 1.004–1.025) were independent risk factors for postoperative chylous ascites. All patients with chylous ascites were managed conservatively, without surgical intervention. The postoperative hospital stay was similar between the two groups (9.4 vs. 9.2 days, p = 0.467). After a median follow-up of 37 months (range 0–118 months), no significant difference was observed in the 3-year disease-free survival (85.0 vs. 83.9 %, p = 0.408) and 5-year overall survival (93.0 vs. 89.7 %, p = 0.662) between the two groups.

Conclusions

A major drawback of this study was that the definition of chylous ascites was solely based on clinical signs. Nevertheless, we can conclude that chylous ascites after colorectal cancer surgery is associated with a shorter operative time and the number of retrieved lymph nodes, but is not associated with the short-term and long-term outcomes.
Literatur
1.
Zurück zum Zitat Kaas R, Rustman LD, Zoetmulder FA (2001) Chylous ascites after oncological abdominal surgery: incidence and treatment. Eur J Surg Oncol 27:187–189CrossRefPubMed Kaas R, Rustman LD, Zoetmulder FA (2001) Chylous ascites after oncological abdominal surgery: incidence and treatment. Eur J Surg Oncol 27:187–189CrossRefPubMed
3.
Zurück zum Zitat Baek SJ, Kim SH, Kwak JM, Kim J (2013) Incidence and risk factors of chylous ascites after colorectal cancer surgery. Am J Surg 206:555–559CrossRefPubMed Baek SJ, Kim SH, Kwak JM, Kim J (2013) Incidence and risk factors of chylous ascites after colorectal cancer surgery. Am J Surg 206:555–559CrossRefPubMed
4.
Zurück zum Zitat Nishigori H, Ito M, Nishizawa Y, Koyama A, Koda T, Nakajima K, Minagawa N, Nishizawa Y, Kobayashi A, Sugito M, Saito N (2012) Postoperative chylous ascites after colorectal cancer surgery. Surg Today 42:724–728CrossRefPubMed Nishigori H, Ito M, Nishizawa Y, Koyama A, Koda T, Nakajima K, Minagawa N, Nishizawa Y, Kobayashi A, Sugito M, Saito N (2012) Postoperative chylous ascites after colorectal cancer surgery. Surg Today 42:724–728CrossRefPubMed
5.
Zurück zum Zitat Weniger M, D'Haese JG, Angele MK, Kleespies A, Werner J, Hartwig W (2016) Treatment options for chylous ascites after major abdominal surgery: a systematic review. Am J Surg 211:206–213CrossRefPubMed Weniger M, D'Haese JG, Angele MK, Kleespies A, Werner J, Hartwig W (2016) Treatment options for chylous ascites after major abdominal surgery: a systematic review. Am J Surg 211:206–213CrossRefPubMed
6.
Zurück zum Zitat Matsuda T, Fujita H, Kunimoto Y, Kimura T, Ogino K (2013) Chylous ascites as a complication of laparoscopic colorectal surgery. Asian J Endosc Surg 6:279–284CrossRefPubMed Matsuda T, Fujita H, Kunimoto Y, Kimura T, Ogino K (2013) Chylous ascites as a complication of laparoscopic colorectal surgery. Asian J Endosc Surg 6:279–284CrossRefPubMed
7.
Zurück zum Zitat Kim CH, Kim HJ, Huh JW, Kim YJ, Kim HR (2014) Learning curve of laparoscopic low anterior resection in terms of local recurrence. J Surg Oncol 110:989–996CrossRefPubMed Kim CH, Kim HJ, Huh JW, Kim YJ, Kim HR (2014) Learning curve of laparoscopic low anterior resection in terms of local recurrence. J Surg Oncol 110:989–996CrossRefPubMed
8.
Zurück zum Zitat Lim SW, Kim HJ, Kim CH, Huh JW, Kim YJ, Kim HR (2013) Umbilical incision laparoscopic colectomy with one additional port for colorectal cancer. Tech Coloproctol 17:193–199CrossRefPubMed Lim SW, Kim HJ, Kim CH, Huh JW, Kim YJ, Kim HR (2013) Umbilical incision laparoscopic colectomy with one additional port for colorectal cancer. Tech Coloproctol 17:193–199CrossRefPubMed
9.
Zurück zum Zitat Yilmaz M, Akbulut S, Isik B, Ara C, Ozdemir F, Aydin C, Kayaalp C, Yilmaz S (2012) Chylous ascites after liver transplantation: incidence and risk factors. Liver Transpl 18:1046–1052CrossRefPubMed Yilmaz M, Akbulut S, Isik B, Ara C, Ozdemir F, Aydin C, Kayaalp C, Yilmaz S (2012) Chylous ascites after liver transplantation: incidence and risk factors. Liver Transpl 18:1046–1052CrossRefPubMed
10.
Zurück zum Zitat Tulunay G, Ureyen I, Turan T, Karalok A, Kavak D, Ozgul N, Ocalan R, Tapisiz OL, Boran N, Kose MF (2012) Chylous ascites: analysis of 24 patients. Gynecol Oncol 127:191–197CrossRefPubMed Tulunay G, Ureyen I, Turan T, Karalok A, Kavak D, Ozgul N, Ocalan R, Tapisiz OL, Boran N, Kose MF (2012) Chylous ascites: analysis of 24 patients. Gynecol Oncol 127:191–197CrossRefPubMed
11.
Zurück zum Zitat Assumpcao L, Cameron JL, Wolfgang CL, Edil B, Choti MA, Herman JM, Geschwind JF, Hong K, Georgiades C, Schulick RD, Pawlik TM (2008) Incidence and management of chyle leaks following pancreatic resection: a high volume single-center institutional experience. J Gastrointest Surg 12:1915–1923CrossRefPubMed Assumpcao L, Cameron JL, Wolfgang CL, Edil B, Choti MA, Herman JM, Geschwind JF, Hong K, Georgiades C, Schulick RD, Pawlik TM (2008) Incidence and management of chyle leaks following pancreatic resection: a high volume single-center institutional experience. J Gastrointest Surg 12:1915–1923CrossRefPubMed
12.
Zurück zum Zitat Evans JG, Spiess PE, Kamat AM, Wood CG, Hernandez M, Pettaway CA, Dinney CP, Pisters LL (2006) Chylous ascites after post-chemotherapy retroperitoneal lymph node dissection: review of the M. D. Anderson experience. J Urol 176:1463–1467CrossRefPubMed Evans JG, Spiess PE, Kamat AM, Wood CG, Hernandez M, Pettaway CA, Dinney CP, Pisters LL (2006) Chylous ascites after post-chemotherapy retroperitoneal lymph node dissection: review of the M. D. Anderson experience. J Urol 176:1463–1467CrossRefPubMed
13.
Zurück zum Zitat Yol S, Bostanci EB, Ozogul Y, Ulas M, Akoglu M (2005) A rare complication of D3 dissection for gastric carcinoma: chyloperitoneum. Gastric Cancer 8:35–38CrossRefPubMed Yol S, Bostanci EB, Ozogul Y, Ulas M, Akoglu M (2005) A rare complication of D3 dissection for gastric carcinoma: chyloperitoneum. Gastric Cancer 8:35–38CrossRefPubMed
14.
Zurück zum Zitat Omloo JM, Lagarde SM, Vrouenraets BC, Busch OR, van Lanschot JJ (2006) Compartimentalization for chylothorax originating from the abdomen after extended esophagectomy. Report of two cases and review of the literature. Dig Surg 23:86–92CrossRefPubMed Omloo JM, Lagarde SM, Vrouenraets BC, Busch OR, van Lanschot JJ (2006) Compartimentalization for chylothorax originating from the abdomen after extended esophagectomy. Report of two cases and review of the literature. Dig Surg 23:86–92CrossRefPubMed
15.
Zurück zum Zitat Harold KL, Pollinger H, Matthews BD, Kercher KW, Sing RF, Heniford BT (2003) Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries. Surg Endosc 17:1228–1230CrossRefPubMed Harold KL, Pollinger H, Matthews BD, Kercher KW, Sing RF, Heniford BT (2003) Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries. Surg Endosc 17:1228–1230CrossRefPubMed
16.
Zurück zum Zitat van der Gaag NA, Verhaar AC, Haverkort EB, Busch OR, van Gulik TM, Gouma DJ (2008) Chylous ascites after pancreaticoduodenectomy: introduction of a grading system. J Am Coll Surg 207:751–757CrossRefPubMed van der Gaag NA, Verhaar AC, Haverkort EB, Busch OR, van Gulik TM, Gouma DJ (2008) Chylous ascites after pancreaticoduodenectomy: introduction of a grading system. J Am Coll Surg 207:751–757CrossRefPubMed
17.
Zurück zum Zitat Ha GW, Lee MR (2015) Surgical repair of intractable chylous ascites following laparoscopic anterior resection. World J Gastroenterol 21:6077–6081PubMedPubMedCentral Ha GW, Lee MR (2015) Surgical repair of intractable chylous ascites following laparoscopic anterior resection. World J Gastroenterol 21:6077–6081PubMedPubMedCentral
18.
Zurück zum Zitat Leibovitch I, Mor Y, Golomb J, Ramon J (2002) The diagnosis and management of postoperative chylous ascites. J Urol 167:449–457CrossRefPubMed Leibovitch I, Mor Y, Golomb J, Ramon J (2002) The diagnosis and management of postoperative chylous ascites. J Urol 167:449–457CrossRefPubMed
19.
Zurück zum Zitat Lu J, Wei ZQ, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M (2015) Small-volume chylous ascites after laparoscopic radical gastrectomy for gastric cancer: results from a large population-based sample. World J Gastroenterol 21:2425–2432CrossRefPubMedPubMedCentral Lu J, Wei ZQ, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M (2015) Small-volume chylous ascites after laparoscopic radical gastrectomy for gastric cancer: results from a large population-based sample. World J Gastroenterol 21:2425–2432CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Zhang HY, Zhao CL, Xie J, Ye YW, Sun JF, Ding ZH, Xu HN, Ding L (2016) To drain or not to drain in colorectal anastomosis: a meta-analysis. Int J Color Dis 31:951–960CrossRef Zhang HY, Zhao CL, Xie J, Ye YW, Sun JF, Ding ZH, Xu HN, Ding L (2016) To drain or not to drain in colorectal anastomosis: a meta-analysis. Int J Color Dis 31:951–960CrossRef
Metadaten
Titel
Chylous ascites after colorectal cancer surgery: risk factors and impact on short-term and long-term outcomes
verfasst von
Soo Young Lee
Chang Hyun Kim
Young Jin Kim
Hyeong Rok Kim
Publikationsdatum
24.08.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 8/2016
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-016-1500-6

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