Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2022; 28(42): 6056-6067
Published online Nov 14, 2022. doi: 10.3748/wjg.v28.i42.6056
Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery
Peng-Fei Kong, Yong-Hu Xu, Zhi-Hua Lai, Ming-Zhe Ma, Yan-Tao Duan, Bo Sun, Da-Zhi Xu
Peng-Fei Kong, Yong-Hu Xu, Ming-Zhe Ma, Yan-Tao Duan, Bo Sun, Da-Zhi Xu, Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Zhi-Hua Lai, Department of the General Surgery, Suzhou Industrial Park Xinghai Hospital, Suzhou 215124, Jiangsu Province, China
Author contributions: Kong PF and Xu YH contributed equally to this work; Xu DZ designed the research study; Kong PF, Xu YH, Lai ZH and Sun B performed the research; Kong PF, Xu YH, Ma MZ and Duan YT analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by Ethics Committee of Fudan University Shanghai Cancer Center Review Board [Approval No. FUSCC-D-2021-164].
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset available from the corresponding author at xudzh@shca.org.cn. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Da-Zhi Xu, MD, PhD, Chief Doctor, Professor, Surgeon, Department of Gastric Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong’an Road, Shanghai 200032, China. xudzh@shca.org.cn
Received: June 27, 2022
Peer-review started: June 27, 2022
First decision: August 1, 2022
Revised: August 15, 2022
Accepted: October 26, 2022
Article in press: October 26, 2022
Published online: November 14, 2022
Abstract
BACKGROUND

Chylous ascites (CA) presents a challenge as a relatively common postoperative complication in gastric cancer (GC). Primary conservative therapy involved total parenteral nutrition, continuous low-pressure drainage, somatostatin, and a low-fat diet. Drainage tube (DT) clamping has been presented as a potential alternative conservative treatment for GC patients with CA.

AIM

To propose novel conservative treatment strategies for CA following GC surgery.

METHODS

The data of patients with CA after GC surgery performed at the Fudan University Shanghai Cancer Center between 2006 and 2021 were evaluated retrospectively.

RESULTS

53 patients underwent surgery for GC and exhibited postoperative CA during the study period. Postoperative hospitalization and time of DT removal showed a significant positive association (R2 = 0.979, P < 0.001). We further observed that delayed DT removal significantly extended the total and postoperative hospitalization, antibiotic usage duration, and hospitalization cost (postoperative hospitalization: 25.8 d vs 15.5 d, P < 0.001; total hospitalization: 33.2 d vs 24.7 d, P < 0.01; antibiotic usage duration: 10.8 d vs 6.2 d, P < 0.01; hospitalization cost: ¥9.2 × 104vs ¥6.5 × 104, P < 0.01). Multivariate analysis demonstrated that postoperative infection and antibiotic usage were independent factors for delayed DT removal. Furthermore, DT removal times were shorter in seven patients who underwent DT clamping (clamped DT vs normal group, 11.8 d vs 13.6 d, P = 0.047; clamped DT vs delayed group, 13.6 d vs 27.4 d, P < 0.001). In addition, our results indicated that removal of the DT may be possible after three consecutive days of drainage volumes less than 300 mL in GC patients with CA.

CONCLUSION

Infection and antibiotic usage were vital independent factors that influenced delayed DT removal in patients with CA. Appropriate standards for DT removal can significantly reduce the duration of hospitalization. Furthermore, DT clamping might be a recommended option for conservative treatment of postoperative CA.

Keywords: Gastric cancer, Chylous ascites, Conservative treatment, Drainage tube

Core Tip: Chylous ascites (CA) is one of uncommon postoperative complication in the patients received gastric cancer (GC) surgery. Previously, the primary treatment for CA was conservative therapy, which mainly involved total parenteral nutrition, continuous low-pressure drainage, somatostatin, and a low-fat diet. Therefore, we retrospectively analyzed the patients with CA after GC surgery in our center, aiming to explore the vital factors that influence CA treatment and recommend novel conservative treatment strategies for postoperative CA in GC.