Management of Chylous Acid in Gynecological Malignancies

Objective: Chylous ascites developing in the abdomen after lymphadenectomy in patients with gynecological malignancies is a rare complication. In this study, we attempted to establish a standard approach for the management of chylous ascites on the basis of our clinical experience. The diagnosis, management, and possible outcomes of chylous ascites were evaluated. Materials and Methods: Between 2020 and 2024, 867 patients who underwent lymphadenectomy for gynecological malignancies at the Gynecological Oncology Clinic of Başakşehir Çam and Sakura City Hospital were retrospectively examined. Results: Chylous ascites (CA) developed in 61 (7%) of 867 patients after surgery. The mean age was 55 years, the body mass index was 31, and the mean hospitalization duration was 10 days. All patients underwent retroperitoneal lymphatic dissection. Paraaortic lymph node dissection was performed in 95.1% of the patients. In 32 of the patients (52.5%) with CA, lymphadenectomy was performed up to the level of the left renal vein. All patients who developed CA were treated with conservative management. A medium-chain triglyceride (MCT) diet was started in all patients. Nine patients (14.8%) started total parenteral nutrition (TPN), and 7 patients (11.5%) used octreotide. Patients with CA had greater drain volumes than those without CA, and patients who started TPN and octreotide had greater drain volumes than those who received only MCT. TPN and octreotide users also had longer hospital stays. Conclusions: The mean drainage volumes on postoperative days 1 and 4 were significantly greater in patients with chylous ascites than in those without chylous ascites (650/450 vs. 830/650). There was a significant, strong, and positive correlation between the amount of drainage on the fourth day and the day that the TPN started according to the Pearson correlation analysis (p=0.009).