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Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery

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 p...

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Autores principales: Kong, Peng-Fei, Xu, Yong-Hu, Lai, Zhi-Hua, Ma, Ming-Zhe, Duan, Yan-Tao, Sun, Bo, Xu, Da-Zhi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9669821/
https://www.ncbi.nlm.nih.gov/pubmed/36405388
http://dx.doi.org/10.3748/wjg.v28.i42.6056
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author Kong, Peng-Fei
Xu, Yong-Hu
Lai, Zhi-Hua
Ma, Ming-Zhe
Duan, Yan-Tao
Sun, Bo
Xu, Da-Zhi
author_facet Kong, Peng-Fei
Xu, Yong-Hu
Lai, Zhi-Hua
Ma, Ming-Zhe
Duan, Yan-Tao
Sun, Bo
Xu, Da-Zhi
author_sort Kong, Peng-Fei
collection PubMed
description 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 (R(2) = 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 × 10(4) vs ¥6.5 × 10(4), 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.
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spelling pubmed-96698212022-11-18 Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery Kong, Peng-Fei Xu, Yong-Hu Lai, Zhi-Hua Ma, Ming-Zhe Duan, Yan-Tao Sun, Bo Xu, Da-Zhi World J Gastroenterol Retrospective Study 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 (R(2) = 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 × 10(4) vs ¥6.5 × 10(4), 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. Baishideng Publishing Group Inc 2022-11-14 2022-11-14 /pmc/articles/PMC9669821/ /pubmed/36405388 http://dx.doi.org/10.3748/wjg.v28.i42.6056 Text en ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/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/
spellingShingle Retrospective Study
Kong, Peng-Fei
Xu, Yong-Hu
Lai, Zhi-Hua
Ma, Ming-Zhe
Duan, Yan-Tao
Sun, Bo
Xu, Da-Zhi
Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery
title Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery
title_full Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery
title_fullStr Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery
title_full_unstemmed Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery
title_short Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery
title_sort novel management indications for conservative treatment of chylous ascites after gastric cancer surgery
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9669821/
https://www.ncbi.nlm.nih.gov/pubmed/36405388
http://dx.doi.org/10.3748/wjg.v28.i42.6056
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