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.
Similar content being viewed by others
References
Kaas R, Rustman LD, Zoetmulder FA (2001) Chylous ascites after oncological abdominal surgery: incidence and treatment. Eur J Surg Oncol 27:187–189
Cardenas A, Chopra S (2002) Chylous ascites. Am J Gastroenterol 97:1896–1900
Baek SJ, Kim SH, Kwak JM, Kim J (2013) Incidence and risk factors of chylous ascites after colorectal cancer surgery. Am J Surg 206:555–559
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 42:724–728
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 211:206–213
Matsuda T, Fujita H, Kunimoto Y, Kimura T, Ogino K (2013) Chylous ascites as a complication of laparoscopic colorectal surgery. Asian J Endosc Surg 6:279–284
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 110:989–996
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 17:193–199
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 18:1046–1052
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 127:191–197
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 12:1915–1923
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 176:1463–1467
Yol S, Bostanci EB, Ozogul Y, Ulas M, Akoglu M (2005) A rare complication of D3 dissection for gastric carcinoma: chyloperitoneum. Gastric Cancer 8:35–38
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 23:86–92
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 17:1228–1230
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 207:751–757
Ha GW, Lee MR (2015) Surgical repair of intractable chylous ascites following laparoscopic anterior resection. World J Gastroenterol 21:6077–6081
Leibovitch I, Mor Y, Golomb J, Ramon J (2002) The diagnosis and management of postoperative chylous ascites. J Urol 167:449–457
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 21:2425–2432
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 31:951–960
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
The authors received no financial support for this study. The authors declare no conflicts of interest.
Ethical approval
All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was exempted because this retrospective study was harmless to the patients and contained no personal data. It was approved by the institutional review board of our institution.
Rights and permissions
About this article
Cite this article
Lee, S.Y., Kim, C.H., Kim, Y.J. et al. Chylous ascites after colorectal cancer surgery: risk factors and impact on short-term and long-term outcomes. Langenbecks Arch Surg 401, 1171–1177 (2016). https://doi.org/10.1007/s00423-016-1500-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-016-1500-6