Management of Chylous Acid in Gynecological Malignancies

Persistent high-volume drainage on postoperative day 4 may indicate the need for advanced treatment options like TPN or Octreotide in managing chylous ascites.

Summary and findings

This study evaluated the management of chylous ascites in patients with gynecological malignancies after lymphadenectomy. A total of 61 patients developed chylous ascites, with 9 receiving total parenteral nutrition and 7 receiving Octreotide. Interventions led to clinical resolution within a median of 4 days post-initiation.

Abstract

<title>Abstract</title> <p> <bold>Objective:</bold> Chylous ascites (CA) developing in the abdomen after lymphadenectomy in patients with gynecological malignancies is a rare complication. In this study, we aimed to evaluate diagnosis, conservative management, and clinical outcomes of CA, and to identify quantitative drainage thresholds to standardize treatment approach based on our clinical experience. <bold>Materials and Methods:</bold> Between 2020 and 2024, 867 patients who underwent lymphadenectomy for gynecological malignancies at the gynecological oncology clinic were retrospectively examined. Patients were divided into laparotomy and laparoscopy groups. Lymphadenectomy level was divided into four levels to standardize the anatomical extent of the surgery. A total of 61 patients with CA were included in the final analysis. <bold>Results:</bold> Postoperative CA developed in 61 (7%) of 867 patients after surgery. All patients were initially treated conservatively with a medium-chain triglyceride (MCT) diet. Due to persistent high-volume drainage, medical treatment was initiated in 9 patients (14.8%) with total parenteral nutrition (TPN), and in 7 patients (11.5%) with Octreotide, typically on postoperative day (POD) 5. Patients requiring TPN or Octreotide escalation demonstrated significantly higher baseline and interim drainage volumes compared to those managed with MCT diet alone ( <italic>p</italic> < .05). These interventions have led to clinical resolution and successful drain removal within a median of 4 days post-initiation. Both TPN and Octreotide escalation were associated with a longer median hospital stay (13 and 14 days, respectively, vs. 10 days; <italic>p</italic> < .05). <bold>Conclusions:</bold> Pearson correlation and trend analyses confirmed that persistent high-volume drainage on POD 4 strongly correlates with the clinical necessity for TPN escalation ( <italic>p</italic> = .009). A quantitative threshold of 830 mL on POD 4 serves as a significant clinical predictor for standardizing the timing of advanced conservative intervention. </p>

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