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01-12-2019 | Tympanotomy | Original Article

Management of postoperative chylous ascites after surgery for ovarian cancer: a single-institution experience

Authors: Giuseppe Scaletta, Lorena Quagliozzi, Stefano Cianci, Virginia Vargiu, Maria Cristina Mele, Giovanni Scambia, Anna Fagotti

Published in: Updates in Surgery | Issue 4/2019

Abstract

Postoperative chylous ascites is a rare complication from operative trauma to the cisterna chyli or lymphatic vessels in the retroperitoneum. In the present study, we aimed to identify the incidence of postoperative chylous ascites in patients treated for ovarian cancer and to describe its management. We retrospectively reviewed all patients submitted to surgery for ovarian cancer at our Institution from October 2016 to November 2018. We analyzed the clinicopathological features, including the primary tumor histology, stage, grade, surgical procedure, median number of harvested pelvic and para-aortic lymph nodes. We described our experience in the diagnosis and management of chylous ascites. Five hundred and forty-six patients were submitted to surgery for ovarian cancer and 298 patients received pelvic and/or para-aortic lymphadenectomy. Chylous ascites occurred in 8 patients with an incidence of 1.4% in the overall population and a 2.68% among patients receiving lymphadenectomy. All patients received total parenteral nutrition (TPN) with Olimel N4E 2000 mL (Baxter^®) and somatostatin therapy with 0.2 mL per 3 times/day for a median of 9 days (range 7–11). Median hospital stay was 15 days (range 7–16). All patients were successfully managed conservatively and none required surgical correction. Conservative management of chylous ascites with TPN, somatostatin and paracentisis is feasible and effective. These data should be confirmed by prospective multicentric studies.

Frey MK, Ward NM, Caputo TA et al (2012) Lymphatic ascites following pelvic and paraaortic lymphadenectomy procedures for gynecologic malignancies. Gynecol Oncol 125:48–53. https://doi.org/10.1016/j.ygyno.2011.11.012 CrossRefPubMed

Shibuya Y, Asano K, Hayasaka A et al (2013) A novel therapeutic strategy for chylous ascites after gynecological cancer surgery: a continuous low-pressure drainage system. Arch Gynecol Obstet 287:1005–1008. https://doi.org/10.1007/s00404-012-2666-y CrossRefPubMed

Steinemann DC, Dindo D, Clavien P-A, Nocito A (2011) Atraumatic chylous ascites: systematic review on symptoms and causes. J Am Coll Surg 212(899–905):e1–e4. https://doi.org/10.1016/j.jamcollsurg.2011.01.010 CrossRef

Leibovitch I, Mor Y, Golomb J, Ramon J (2002) The diagnosis and management of postoperative chylous ascites. J Urol 167:449–457CrossRef

Han D, Wu X, Li J, Ke G (2012) Postoperative chylous ascites in patients with gynecologic malignancies. Int J Gynecol Cancer 22:186–190. https://doi.org/10.1097/IGC.0b013e318233f24b CrossRefPubMed

Tulunay G, Ureyen I, Turan T et al (2012) Chylous ascites: analysis of 24 patients. Gynecol Oncol 127:191–197. https://doi.org/10.1016/j.ygyno.2012.06.023 CrossRefPubMed

Combe J, Buniet JM, Douge C et al (1992) Chylothorax and chylous ascites following surgery of an inflammatory aortic aneurysm. Case report with review of the literature. J Mal Vasc 17:151–156PubMed

Baniel J, Foster RS, Rowland RG et al (1995) Complications of post-chemotherapy retroperitoneal lymph node dissection. J Urol 153:976–980CrossRef

Baniel J, Foster RS, Rowland RG et al (1993) Management of chylous ascites after retroperitoneal lymph node dissection for testicular cancer. J Urol 150:1422–1424CrossRef

10.

DeHart MM, Lauerman WC, Conely AH et al (1994) Management of retroperitoneal chylous leakage. Spine (Phila Pa 1976) 19:716–718CrossRef

11.

Zhao Y, Hu W, Hou X, Zhou Q (2014) Chylous ascites after laparoscopic lymph node dissection in gynecologic malignancies. J Minim Invasive Gynecol 21:90–96. https://doi.org/10.1016/j.jmig.2013.07.005 CrossRefPubMed

12.

Gueli Alletti S, Vizzielli G, Lafuenti L et al (2018) Single-Institution propensity-matched study to evaluate the psychological effect of minimally invasive interval debulking surgery versus standard laparotomic treatment: from body to mind and back. J Minim Invasive Gynecol 25:816–822. https://doi.org/10.1016/j.jmig.2017.12.007 CrossRefPubMed

13.

Petrillo M, De Iaco P, Cianci S et al (2016) Long-term survival for platinum-sensitive recurrent ovarian cancer patients treated with secondary cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol 23:1660–1665. https://doi.org/10.1245/s10434-015-5050-x CrossRefPubMed

14.

Plotti F, Scaletta G, Terranova C et al (2018) The role of novel biomarker HE4 in gynecologic malignancies. Minerva Ginecol. https://doi.org/10.23736/s0026-4784.18.04328-9 CrossRefPubMed

15.

Valenti G, Vitale SG, Tropea A et al (2017) Tumor markers of uterine cervical cancer: a new scenario to guide surgical practice? Updates Surg 69:441–449. https://doi.org/10.1007/s13304-017-0491-3 CrossRefPubMed

16.

Angioli R, Capriglione S, Aloisi A et al (2015) A predictive score for secondary cytoreductive surgery in recurrent ovarian cancer (SeC-Score): a single-centre, controlled study for preoperative patient selection. Ann Surg Oncol 22:4217–4223. https://doi.org/10.1245/s10434-015-4534-z CrossRefPubMed

17.

Vitale SG, Capriglione S, Zito G et al (2019) Management of endometrial, ovarian and cervical cancer in the elderly: current approach to a challenging condition. Arch Gynecol Obstet 299:299–315. https://doi.org/10.1007/s00404-018-5006-z CrossRefPubMed

18.

Plotti F, Scaletta G, Aloisi A et al (2015) Quality of life in platinum-sensitive recurrent ovarian cancer: chemotherapy versus surgery plus chemotherapy. Ann Surg Oncol 22:2387–2394. https://doi.org/10.1245/s10434-014-4263-8 CrossRefPubMed

19.

Plotti F, Montera R, Aloisi A et al (2016) Total rectosigmoidectomy versus partial rectal resection in primary debulking surgery for advanced ovarian cancer. Eur J Surg Oncol 42:383–390. https://doi.org/10.1016/j.ejso.2015.12.001 CrossRefPubMed

20.

Vitale SG, Valenti G, Gulino FA et al (2016) Surgical treatment of high stage endometrial cancer: current perspectives. Updates Surg 68:149–154CrossRef

21.

Rossetti D, Vitale SG, Gulino FA et al (2016) Laparoendoscopic single-site surgery for the assessment of peritoneal carcinomatosis resectability in patients with advanced ovarian cancer. Eur J Gynaecol Oncol 37:671–673. https://doi.org/10.12892/ejgo3234.2016 CrossRefPubMed

22.

Fagotti A, Costantini B, Gallotta V et al (2015) Minimally invasive secondary cytoreduction plus HIPEC versus open surgery plus HIPEC in isolated relapse from ovarian cancer: a retrospective cohort study on perioperative outcomes. J Minim Invasive Gynecol 22:428–432. https://doi.org/10.1016/j.jmig.2014.11.008 CrossRefPubMed

23.

Cianci S, Ronsini C, Vizzielli G et al (2018) Cytoreductive surgery followed by HIPEC repetition for secondary ovarian cancer recurrence. Updates Surg. https://doi.org/10.1007/s13304-018-0600-y CrossRefPubMed

24.

Cianci S, Abatini C, Fagotti A et al (2018) Hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies using new hybrid CO₂ system: preliminary experience in referral center. Updates Surg. https://doi.org/10.1007/s13304-018-0578-5 CrossRefPubMed

25.

Bellia A, Vitale SG, Laganà AS et al (2016) Feasibility and surgical outcomes of conventional and robot-assisted laparoscopy for early-stage ovarian cancer: a retrospective, multicenter analysis. Arch Gynecol Obstet 294:615–622. https://doi.org/10.1007/s00404-016-4087-9 CrossRefPubMed

26.

Gueli Alletti S, Perrone E, Cianci S et al (2018) 3 mm Senhance robotic hysterectomy: a step towards future perspectives. J Robot Surg. https://doi.org/10.1007/s11701-018-0778-5 CrossRefPubMed

27.

Gallotta V, Conte C, Giudice MT et al (2017) Secondary laparoscopic cytoreduction in recurrent ovarian cancer: a large, single-Institution experience. J Minim Invasive Gynecol 25(4):644–650CrossRef

28.

Rossitto C, Cianci S, Gueli Alletti S et al (2017) Laparoscopic, minilaparoscopic, single-port and percutaneous hysterectomy: comparison of perioperative outcomes of minimally invasive approaches in gynecologic surgery. Eur J Obstet Gynecol Reprod Biol 216:125–129. https://doi.org/10.1016/j.ejogrb.2017.07.026 CrossRefPubMed

29.

Lagana AS, Vitale SG, De Dominici R et al (2016) Fertility outcome after laparoscopic salpingostomy or salpingectomy for tubal ectopic pregnancy A 12-years retrospective cohort study. Annali italiani di chirurgia 87:461–465PubMed

30.

Rahn DD, Mamik MM, Sanses TVD et al (2011) Venous thromboembolism prophylaxis in gynecologic surgery: a systematic review. Obstet Gynecol 118:1111–1125. https://doi.org/10.1097/AOG.0b013e318232a394 CrossRefPubMed

31.

Gueli Alletti S, Rossitto C, Cianci S et al (2018) The Senhance™ surgical robotic system (“Senhance”) for total hysterectomy in obese patients: a pilot study. J Robot Surg 12:229–234. https://doi.org/10.1007/s11701-017-0718-9 CrossRefPubMed

32.

Gueli Alletti S, Rossitto C, Perrone E et al (2017) Needleoscopic conservative staging of borderline ovarian tumor. J Minim Invasive Gynecol 24:529–530. https://doi.org/10.1016/j.jmig.2016.10.009 CrossRefPubMed

33.

Rossitto C, Gueli Alletti S, Rotolo S et al (2016) Total laparoscopic hysterectomy using a percutaneous surgical system: a pilot study towards scarless surgery. Eur J Obstet Gynecol Reprod Biol 203:132–135. https://doi.org/10.1016/j.ejogrb.2016.05.007 CrossRefPubMed

34.

Vitale SG, Gasbarro N, Lagana AS et al (2016) Safe introduction of ancillary trocars in gynecological surgery: the “yellow island” anatomical landmark. Annali italiani di chirurgia 87:608–611PubMed

35.

Gueli Alletti S, Rossitto C, Cianci S et al (2016) Telelap ALF-X vs standard laparoscopy for the treatment of early-stage endometrial cancer: a single-institution retrospective cohort study. J Minim Invasive Gynecol 23:378–383. https://doi.org/10.1016/j.jmig.2015.11.006 CrossRefPubMed

36.

Chambers LM, Vargas R, Michener CM (2019) Sentinel lymph node mapping in endometrial and cervical cancer: a survey of practices and attitudes in gynecologic oncologists. J Gynecol Oncol 30:e35. https://doi.org/10.3802/jgo.2019.30.e35 CrossRefPubMed

37.

Ballester M, Dubernard G, Rouzier R et al (2008) Use of the sentinel node procedure to stage endometrial cancer. Ann Surg Oncol 15:1523–1529. https://doi.org/10.1245/s10434-008-9841-1 CrossRefPubMed

38.

Cignini P, Vitale SG, Laganà AS et al (2017) Preoperative work-up for definition of lymph node risk involvement in early stage endometrial cancer: 5-year follow-up. Updates Surg 69:75–82. https://doi.org/10.1007/s13304-017-0418-z CrossRefPubMed

39.

Capriglione S, Luvero D, Plotti F et al (2017) Ovarian cancer recurrence and early detection: may HE4 play a key role in this open challenge? A systematic review of literature. Med Oncol 34:164. https://doi.org/10.1007/s12032-017-1026-y CrossRefPubMed

40.

Scaletta G, Plotti F, Luvero D et al (2017) The role of novel biomarker HE4 in the diagnosis, prognosis and follow-up of ovarian cancer: a systematic review. Expert Rev Anticancer Ther 17:827–839. https://doi.org/10.1080/14737140.2017.1360138 CrossRefPubMed

41.

Plotti F, Capriglione S, Terranova C et al (2012) Does HE4 have a role as biomarker in the recurrence of ovarian cancer? Tumour Biol 33:2117–2123. https://doi.org/10.1007/s13277-012-0471-7 CrossRefPubMed

42.

Plotti F, Scaletta G, Capriglione S et al (2017) The role of HE4, a novel biomarker, in predicting optimal cytoreduction after neoadjuvant chemotherapy in advanced ovarian cancer. Int J Gynecol Cancer 27:696–702. https://doi.org/10.1097/IGC.0000000000000944 CrossRefPubMed

43.

Angioli R, Plotti F, Capriglione S et al (2016) Preoperative local staging of endometrial cancer: the challenge of imaging techniques and serum biomarkers. Arch Gynecol Obstet 294:1291–1298. https://doi.org/10.1007/s00404-016-4181-z CrossRefPubMed

44.

Angioli R, Plotti F, Aloisi A et al (2015) A randomized controlled trial comparing four versus six courses of adjuvant platinum-based chemotherapy in locally advanced cervical cancer patients previously treated with neo-adjuvant chemotherapy plus radical surgery. Gynecol Oncol 139:433–438. https://doi.org/10.1016/j.ygyno.2015.09.082 CrossRefPubMed

45.

Paris I, Cianci S, Vizzielli G et al (2018) Upfront HIPEC and bevacizumab-containing adjuvant chemotherapy in advanced epithelial ovarian cancer. Int J Hyperth. https://doi.org/10.1080/02656736.2018.1503346 CrossRef

46.

Tozzi R, Giannice R, Cianci S et al (2015) Neo-adjuvant chemotherapy does not increase the rate of complete resection and does not significantly reduce the morbidity of Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC–IV ovarian cancer. Gynecol Oncol 138:252–258. https://doi.org/10.1016/j.ygyno.2015.05.010 CrossRefPubMed

47.

Capriglione S, Plotti F, Montera R et al (2016) Role of paroxetine in the management of hot flashes in gynecological cancer survivors: results of the first randomized single-center controlled trial. Gynecol Oncol 143:584–588. https://doi.org/10.1016/j.ygyno.2016.10.006 CrossRefPubMed

48.

Vitale SG, Caruso S, Rapisarda AMC et al (2018) Isoflavones, calcium, vitamin D and inulin improve quality of life, sexual function, body composition and metabolic parameters in menopausal women: result from a prospective, randomized, placebo-controlled, parallel-group study. Prz Menopauzalny 17:32–38. https://doi.org/10.5114/pm.2018.73791 CrossRefPubMedPubMedCentral

49.

Caruso S, Agnello C, Romano M et al (2011) Preliminary study on the effect of four-phasic estradiol valerate and dienogest (E2V/DNG) oral contraceptive on the quality of sexual life. J Sex Med 8:2841–2850. https://doi.org/10.1111/j.1743-6109.2011.02409.x CrossRefPubMed

50.

Caruso S, Cianci S, Vitale SG et al (2018) Sexual function and quality of life of women adopting the levonorgestrel-releasing intrauterine system (LNG-IUS 13.5 mg) after abortion for unintended pregnancy. Eur J Contracept Reprod Heal Care 23:24–31. https://doi.org/10.1080/13625187.2018.1433824 CrossRef

Title: Management of postoperative chylous ascites after surgery for ovarian cancer: a single-institution experience
Authors: Giuseppe Scaletta
Lorena Quagliozzi
Stefano Cianci
Virginia Vargiu
Maria Cristina Mele
Giovanni Scambia
Anna Fagotti
Publication date: 01-12-2019
Publisher: Springer International Publishing
Keywords: Tympanotomy
Nutrition
Ovarian Cancer
Ovarian Cancer
Ascites
Lymphadenectomy
Published in: Updates in Surgery / Issue 4/2019
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-019-00656-x

Keynote webinar | Spotlight on medication adherence

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Management of postoperative chylous ascites after surgery for ovarian cancer: a single-institution experience

Abstract

Keynote webinar | Spotlight on medication adherence

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Abstract

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