Chylous ascites: analysis of 24 patients.
OBJECTIVE
Chylous ascites is the pathologic accumulation of lymphatic fluid in the peritoneal cavity. Patients who underwent surgery for gynecologic malignancy and had postoperative chylous ascites were evaluated retrospectively.


METHODS
We reviewed 1514 patients who had staging surgery for gynecologic malignancy at our institution from January 2003 to February 2012. We analyze the patients who develop chylous ascites and who didn't.


RESULTS
Twenty-four (2%) patients had postoperative chylous ascites. In the patients with chylous ascites, the median number of removed para-aortic lymph nodes was 26 (range 8-54), while this number was 17 (range 1-76) for the patients who didn't develop chylous ascites (p=0.001). Among the patients with chylous ascites, nine patients took chylous diet and 15 patients took TPN as the initial treatment. Totally seven (29%) patients required surgical correction, since 17 (71%) responded to conservative treatment. In the TPN group, the time from staging surgery to the diagnosis of chylous ascites was significantly longer in the group who required surgery compared with the group who did not (20 days vs 8 days, p:0.037). In addition this time wasn't statistically different from the patients' time in the diet group who didn't require surgery.


CONCLUSIONS
The aggressiveness of para-aortic lymphadenectomy should be individualized and the lymphatics should be controlled with suture ligation or hemoclips, since the extent and method of para-aortic lymphadenectomy has a determinative role in the development of chylous ascites. It may be logical to treat chylous ascites with diet rather than TPN initially in case the symptoms occur later.
Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Gynecologic Oncology Clinic, Ankara, Turkey.
Gokhan
G
Tulunay
Isin
I
Ureyen
Taner
T
Turan
Alper
A
Karalok
Duygu
D
Kavak
Nejat
N
Ozgul
Reyhan
R
Ocalan
Omer Lutfi
OL
Tapisiz
Nurettin
N
Boran
Mehmet Faruk
MF
Kose
D000293:Adolescent; D000328:Adult; D000368:Aged; D002915:Chylous Ascites / Q000473:pathology*; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology; D012189:Retrospective Studies; D055815:Young Adult