title: Chylous ascites following retroperitoneal lymphadenectomy in gynecologic malignancies: incidence, risk factors and management.
abstract: BACKGROUND
  Chylous ascites is a rare form of ascites that results from accumulated lymph fluid in the peritoneal cavity caused by blocked or disrupted lymph flow through the major lymphatic channels. In the present study, our aim was to analyze the incidence, risk factors, diagnostic evaluation and management of chylous ascites after lymphadenectomy in gynecologic malignancies.
  
  
  METHODS
  A total of 458 patients who had undergone staging surgery for gynecologic malignancies at our institution between January 2010 and December 2013 were retrospectively reviewed. After the exclusion criteria were applied, 399 patients were divided into 2 groups based on the presence (n = 36) or absence (n = 363) of chylous ascites.
  
  
  RESULTS
  Among the 399 patients, 36 (9%) developed chylous ascites. The median time to onset was 4 days (range, 2-7 days). The analysis of the various features of lymphadenectomy showed that the number of para-aortic lymph nodes (PALNs) removed was significantly greater in the patients with chylous ascites (p < 0.001). A cut-off value of >14 PALNs was a good predictor of chylous ascites. In all patients, chylous ascites resolved with conservative management.
  
  
  CONCLUSIONS
  Postoperative chylous ascites was strongly associated with the number of harvested PALNs. According to our findings, we suggest that conservative treatment should be the first step in managing patients with chylous ascites. Using an abdominal drain after surgery seems to be an effective diagnostic tool and treatment method for chylous ascites.
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Ulas
authors.initials: U
authors.lastname: Solmaz
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey. Electronic address: volkanturan@yahoo.com.
authors.forename: Volkan
authors.initials: V
authors.lastname: Turan
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Mat
authors.affiliation: Department of Obstetrics and Gynecology, Van Training and Research Hospital, Van, Turkey.
authors.forename: Murat Levent
authors.initials: ML
authors.lastname: Dereli
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Atalay
authors.initials: A
authors.lastname: Ekin
authors.affiliation: Department of Obstetrics and Gynecology, Elazıg Training and Research Hospital, Elazıg, Turkey.
authors.forename: Nuri
authors.initials: N
authors.lastname: Peker
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Tosun
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Askin
authors.initials: A
authors.lastname: Dogan
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gokcu
authors.affiliation: Department of Gynecologic Oncology, Tepecik Training and Research Hospital, Izmir, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Sanci
mesh_terms: D000328:Adult; D000368:Aged; D002915:Chylous Ascites / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Chylous ascites; Conservative treatment; Drain; Gynecologic malignancy; Lymphadenectomy