Advertisement

Strahlentherapie und Onkologie

, Volume 191, Issue 5, pp 448–452 | Cite as

Successful radiation treatment of chylous ascites following pancreaticoduodenectomy

  • Stefanie Corradini
  • Sylke Liebig
  • Olivier M Niemoeller
  • Felix Zwicker
  • Wolfram Lamadé
Case Study

Abstract

Chylous ascites is a rare complication following pancreaticoduodenectomy. We report on a case of chylous ascites following pancreaticoduodenectomy in a 76-year-old patient diagnosed with pancreatic cancer. There are various known conservative management strategies, including dietary measures or total parenteral nutrition. Unfortunately, conservative treatment—with total parenteral nutrition and fasting over a period of 4 weeks—was not successful in the present case. The daily output volume of chylous ascites was up to 2500 ml/day. Based on clinical experiences with successfully treated lymphocutaneous fistulas, low-dose radiotherapy was initiated. External beam radiotherapy comprising a total dose of 8.0 Gy to the paraaortic lymph node region was administered in daily single fractions of 1.0 Gy (five fractions/week). Throughout the course of external beam radiotherapy, the secretion of abdominal ascites rapidly decreased, resulting in complete resolution after 2 weeks. There was no clinical evidence of chylous ascites on follow-up. As a result of this experience, we believe that external beam radiotherapy should be considered as an alternative therapy in refractory cases of chylous ascites.

Keywords

Radiotherapy Pancreatic cancer Lymphadenectomy Chylous ascites Pancreaticoduodenectomy 

Erfolgreiche strahlentherapeutische Behandlung eines Chyloperitoneums nach Pankreatikoduodenektomie

Zusammenfassung

Das Chyloperitoneum ist eine seltene Komplikation nach Pankreatikoduodenektomie. Wir berichten über einen 76-jährigen Patienten mit Chyloperitoneum nach Resektion eines Pankreaskarzinoms. Die konservativen Therapiestrategien, wie beispielsweise diätetische Maßnahmen oder totale parenterale Ernährung, waren im vorliegenden Fall über einen Zeitraum von 4 Wochen nicht erfolgreich. Es bestand eine persistierende Sekretion von Chylaszites von bis zu 2500 ml/Tag. Basierend auf den klinischen Erfahrungen bei erfolgreich behandelten lymphokutanen Fisteln, wurde eine perkutane Radiotherapie eingeleitet. Die Bestrahlung des paraaortalen Lymphabflusses über ventrodorsale Gegenfelder wurde bis zu einer Gesamtdosis von 8,0 Gy in 1,0 Gy Einzeldosis (5 Fraktionen/Woche) durchgeführt. Bereits im Verlauf der Behandlung zeigte sich die Sekretion von Chylaszites deutlich rückläufig und sistierte nach 2 Wochen vollständig. Aufgrund dieser klinischen Erfahrung sind wir der Auffassung, dass eine perkutane Bestrahlung in therapierefraktären Fällen von Chyloperitoneum als Therapieoption in Betracht gezogen werden sollte.

Schlüsselwörter

Strahlentherapie Pankreaskarzinom Lymphadenektomie Chyloperitoneum Pankreatikoduodenektomie 

Notes

Compliance with ethical guidelines

Conflict of interest

S. Corradini, S. Liebig, O.M. Niemoeller, F. Zwicker, and W. Lamadé state that there are no conflicts of interest. Informed consent was obtained from all patients included in studies. Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.

References

  1. 1.
    Aalami OO, Allen DB, Organ Jr CH (2000) Chylous ascites: a collective review. Surgery 128:761–778CrossRefPubMedGoogle Scholar
  2. 2.
    Boran N, Cil AP, Tulunay G, Ozgul N, Kose MF (2004) Chylous ascites following para-aortic lymphadenectomy: a case report. Gynecol Oncol 93:711–714CrossRefPubMedGoogle Scholar
  3. 3.
    Caravatta L, Sallustio G, Pacelli F (2012) et al Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer. Radiat Oncol 7:86CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Eom K, Chie EK, Kim K et al (2013) Postoperative chemoradiotherapy following pancreaticoduodenectomy. Strahlenther Onkol 189:753–758CrossRefPubMedGoogle Scholar
  5. 5.
    Fokas E, Eccles C, Patel N et al (2013) Comparison of four target volume definitions for pancreatic cancer. Strahlenther Onkol 189:407–416CrossRefPubMedGoogle Scholar
  6. 6.
    Huang Q, Jiang ZW, Jiang J, Li N, Li JS (2004) Chylous ascites: treated with total parenteral nutrition and somatostatin. World J Gastroenterol 10:2588–2591PubMedGoogle Scholar
  7. 7.
    Kim YJ, Lee WJ, Woo SM et al (2013) Comparison of capecitabine and 5-fluorouracil in chemoradiotherapy for locally advanced pancreatic cancer. Radiat Oncol 8:160CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Leibovitch I, Mor Y, Golomb J, Ramon J (2002) Chylous ascites after radical nephrectomy and inferior vena cava thrombectomy. Successful conservative management with somatostatin analogue. Eur Urol 41:220–222CrossRefPubMedGoogle Scholar
  9. 9.
    Malik HZ, Crozier J, Murray L, Carter R (2007) Chyle leakage and early enteral feeding following pancreatico-duodenectomy: management options. Dig Surg 24:418–422CrossRefPubMedGoogle Scholar
  10. 10.
    Mayer R, Sminia P, McBride WH et al (2005) Lymphatic fistulas: obliteration by low-dose radiotherapy. Strahlenther Onkol 181:660–664CrossRefPubMedGoogle Scholar
  11. 11.
    McCray S, Parrish CR (2004) When chyle leaks: Nutrition management options. Practical Gastroenterol 17:60–77Google Scholar
  12. 12.
    Nakamura A, Itasaka S, Takaori K et al (2014) Radiotherapy for patients with isolated local recurrence of primary resected pancreatic cancer. Strahlenther Onkol 190:485–490CrossRefPubMedGoogle Scholar
  13. 13.
    Pérez J, Arribas JM, Cárdenas E, Gutiérrez F, Taboada R, Cassinello N (2013) Radiotherapeutic management of the chyloperitoneum following abdominal aortic aneurysm repair. J Vasc Surg 1:409–411Google Scholar
  14. 14.
    Takeuchi S, Kinoshita H, Terasawa K, Minami S (2006) Chylous ascites following operation for para-aortic lymph node dissection in a patient with cervical cancer. Int J GynecolCancer 16:418–422CrossRefGoogle Scholar
  15. 15.
    van der Gaag NA Verhaar AC Haverkort EB Busch ORC van Gulik TM Gouma DJ (2008) Chylous Ascites after pancreaticoduodenectomy: introduction of a grading system. J Am Coll Surg 207:751–757CrossRefPubMedGoogle Scholar
  16. 16.
    Wagayama H, Tanaka T, Shimomura M, Ogura K, Shiraki K (2002) CASE REPORT: pancreatic cancer with chylous ascites demonstrated by lymphoscintigraphy: successful treatment with peritoneovenous shunting. Dig Dis Sci 47:1836–1838CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Stefanie Corradini
    • 1
  • Sylke Liebig
    • 2
  • Olivier M Niemoeller
    • 1
  • Felix Zwicker
    • 2
    • 3
  • Wolfram Lamadé
    • 4
  1. 1.Department of Radiation OncologyUniversity of MunichMunichGermany
  2. 2.Gemeinschaftspraxis Prof. Zwicker & PartnerKonstanzGermany
  3. 3.Clinical Cooperation Unit Molecular and Radiation OncologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
  4. 4.Allgemein- & ViszeralchirurgieHelios PrivatklinikÜberlingenGermany

Personalised recommendations