Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2425-2432
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2425
Small-volume chylous ascites after laparoscopic radical gastrectomy for gastric cancer: Results from a large population-based sample
Jun Lu, Zhen-Quan Wei, Chang-Ming Huang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-Long Cao, Mi Lin
Jun Lu, Chang-Ming Huang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-Long Cao, Mi Lin, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Zhen-Quan Wei, Department of General Surgery, Sanming No. 2 Hospital, Yong’an 366000, Fujian Province, China
Author contributions: Lu J, Wei ZQ and Huang CM conceived the study, analysed the data, and drafted the manuscript; Zheng CH, Li P and Xie JW helped to critically revise the manuscript for important intellectual content; Wang JB, Lin JX, Chen QY, Cao LL and Lin M helped collect the data and design the study; all authors read and approved the final manuscript.
Supported by Grants from National Key Clinical Specialty Discipline Construction Program of China, No. [2012]649.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chang-Ming Huang, Professor, Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. hcmlr2002@163.com
Telephone: +86-591-83363366 Fax: +86-591-83320319
Received: August 12, 2014
Peer-review started: August 13, 2014
First decision: September 27, 2014
Revised: October 2, 2014
Accepted: October 21, 2014
Article in press: October 21, 2014
Published online: February 28, 2015
Processing time: 199 Days and 17.5 Hours
Abstract

AIM: To report the incidence and potential risk factors of small-volume chylous ascites (SVCA) following laparoscopic radical gastrectomy (LAG).

METHODS: A total of 1366 consecutive gastric cancer patients who underwent LAG from January 2008 to June 2011 were enrolled in this study. We analyzed the patients based on the presence or absence of SVCA.

RESULTS: SVCA was detected in 57 (4.17%) patients, as determined by the small-volume drainage (range, 30-100 mL/24 h) of triglyceride-rich fluid. Both univariate and multivariate analyses revealed that the total number of resected lymph nodes (LNs), No. 8 or No. 9 LN metastasis and N stage were independent risk factors for SVCA following LAG (P < 0.05). Regarding hospital stay, there was a significant difference between the groups with and without SVCA (P < 0.001). The 3-year disease-free and overall survival rates of the patients with SVCA were 47.4% and 56.1%, respectively, which were similar to those of the patients without SVCA (P > 0.05).

CONCLUSION: SVCA following LAG developed significantly more frequently in the patients with ≥ 32 harvested LNs, ≥ 3 metastatic LNs, or No. 8 or No. 9 LN metastasis. SVCA, which was successfully treated with conservative management, was associated with a prolonged hospital stay but was not associated with the prognosis.

Keywords: Gastric cancer; Laparoscopic gastrectomy; Small volume; Chylous ascites

Core tip: Postoperative chylous ascites (CA) following abdominal surgery is uncommon. Laparoscopic radical gastrectomy (LAG) has been increasingly used as a promising approach to manage gastric cancer. However, in the field of LAG surgery, no large studies have been conducted focusing on postoperative CA. Therefore, we conducted the current study to evaluate the incidence, management, and predisposing factors of CA, as well as the impact of CA on outcomes after LAG. This is the first study to evaluate SVCA after LAG in a large population with the aim of identifying the potential risk factors for its onset and determining the appropriate treatment.