title: Chylous ascites in gynecologic malignancies: cases report and literature review.
abstract: OBJECTIVE
  Chylous ascites is an infrequent postoperative complication after retroperitoneal surgical procedure. Despite its infrequent occurrence, postoperative chylous ascites are associated with significant morbidity. Reports of chylous ascites or fistula after retroperitoneal lymph node dissection for gynecologic malignancies without radiation therapy are rare. A search in the English literature showed only 31 cases of chylous fistula for gynecologic malignancies. Treatment may be conservative with low-fat oral diet with medium-chain triglycerides associated or not to octreotide and total parenteral nutrition. In case of conservative measures failure, it can be managed by surgical intervention or peritoneo-venous shunt.
  
  
  METHODS
  We report two cases of chylous fistula following systematic pelvic and retroperitoneal lymph node dissection for gynecological cancer without radiotherapy and review the literature.
  
  
  RESULTS
  Both were successfully managed with the maintenance of the postoperative drain, total parenteral nutrition, octreotide and dietary intervention.
  
  
  CONCLUSIONS
  Chylous ascites should be included in differential diagnosis of abdominal distention after surgical retroperitoneal approach or radiotherapy. Most of the patients may have their chylous ascites successfully treated with conservative management. However, the best policy is to prevent chylous complications by employing meticulous dissection techniques and careful control of the major lymphatics by suture ligation during the primary surgical intervention.
authors.affiliation: Department of Gynecologic Oncology, Hospital do Câncer AC Camargo, Rua Antonio Prudente 211, São Paulo, Brazil. glbaiocchi@yahoo.com.br
authors.forename: Glauco
authors.initials: G
authors.lastname: Baiocchi
authors.forename: Carlos Chaves
authors.initials: CC
authors.lastname: Faloppa
authors.forename: Raphael Leonardo Cunha
authors.initials: RL
authors.lastname: Araujo
authors.forename: Elza Mieko
authors.initials: EM
authors.lastname: Fukazawa
authors.forename: Lillian Yuri
authors.initials: LY
authors.lastname: Kumagai
authors.forename: Ademir Narciso Oliveira
authors.initials: AN
authors.lastname: Menezes
authors.forename: Levon
authors.initials: L
authors.lastname: Badiglian-Filho
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D018269:Carcinoma, Endometrioid / Q000150:complications*; D002915:Chylous Ascites / Q000209:etiology* / Q000628:therapy; D003536:Cystadenocarcinoma / Q000150:complications*; D016889:Endometrial Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D010051:Ovarian Neoplasms / Q000150:complications*; D010289:Parenteral Nutrition, Total
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide