Conservative management of chylous ascites after oncological surgery for peripheral neuroblastic tumors in pediatric patients

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Abstract

Chylous ascites may complicate the postoperative course of abdominal surgery mainly due to the iatrogenic disruption of the lymphatic channels during extensive retroperitoneal dissection. Sparse data are available regarding treatment; however, in many cases a recommended first-line treatment approach is by way of enteral feeding, consisting of a formula high in medium-chain triglycerides (MCTs) together with a complete total parenteral nutrition teamed with somatostatin (or an equivalent). Nonetheless, the ligation of chylous fistulae, together with the application of Fibrin glue, as well as the creation of peritoneal-venous shunts have also been documented. The aims of this study are to document incidence of postoperative chylous ascites following resection of abdominal peripheral neuroblastic tumors, evaluate efficacy of the management of chylous ascites, and investigate the main risk factors. A survey was carried out over a span of six years, from March 2010 to March 2016 at Giannina Gaslini Children's Hospital involving seventy-seven children with resections of peripheral neuroblastic tumors. Incidence rate of postoperative chylous ascites following a normal diet was 9% (n=7). Treatment using total parenteral nutrition with octreotide resulted in a complete recovery from chylous ascites within a 20 day period without recurrence. Length of operative time, nephrectomy, and the extension of lymphadenectomy were all significantly associated with a higher incidence of postoperative chylous ascites (p<0.05) which also lengthened hospital stay (p<0.05) and possibly delayed beginning adjuvant chemotherapy.

Original languageEnglish
Pages (from-to)25-34
Number of pages10
JournalLymphology
Volume52
Issue number1
Publication statusPublished - Jan 1 2019

Fingerprint

Chylous Ascites
Pediatrics
Neoplasms
Total Parenteral Nutrition
Incidence
Fibrin Tissue Adhesive
Octreotide
Enteral Nutrition
Adjuvant Chemotherapy
Operative Time
Somatostatin
Lymph Node Excision
Nephrectomy
Fistula
Ligation
Conservative Treatment
Dissection
Length of Stay
Triglycerides
Therapeutics

Keywords

  • children
  • chylous ascites
  • octreotide
  • oncological surgery
  • peripheral neuroblastic tumors

ASJC Scopus subject areas

  • Immunology and Allergy
  • Hematology

Cite this

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title = "Conservative management of chylous ascites after oncological surgery for peripheral neuroblastic tumors in pediatric patients",
abstract = "Chylous ascites may complicate the postoperative course of abdominal surgery mainly due to the iatrogenic disruption of the lymphatic channels during extensive retroperitoneal dissection. Sparse data are available regarding treatment; however, in many cases a recommended first-line treatment approach is by way of enteral feeding, consisting of a formula high in medium-chain triglycerides (MCTs) together with a complete total parenteral nutrition teamed with somatostatin (or an equivalent). Nonetheless, the ligation of chylous fistulae, together with the application of Fibrin glue, as well as the creation of peritoneal-venous shunts have also been documented. The aims of this study are to document incidence of postoperative chylous ascites following resection of abdominal peripheral neuroblastic tumors, evaluate efficacy of the management of chylous ascites, and investigate the main risk factors. A survey was carried out over a span of six years, from March 2010 to March 2016 at Giannina Gaslini Children's Hospital involving seventy-seven children with resections of peripheral neuroblastic tumors. Incidence rate of postoperative chylous ascites following a normal diet was 9{\%} (n=7). Treatment using total parenteral nutrition with octreotide resulted in a complete recovery from chylous ascites within a 20 day period without recurrence. Length of operative time, nephrectomy, and the extension of lymphadenectomy were all significantly associated with a higher incidence of postoperative chylous ascites (p<0.05) which also lengthened hospital stay (p<0.05) and possibly delayed beginning adjuvant chemotherapy.",
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author = "L. Pio and F. Boccardo and S. Avanzini and I. Paraboschi and C. Granata and A. Garaventa and S. Dessalvi and G. Martucciello and G. Mattioli",
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AU - Pio, L.

AU - Boccardo, F.

AU - Avanzini, S.

AU - Paraboschi, I.

AU - Granata, C.

AU - Garaventa, A.

AU - Dessalvi, S.

AU - Martucciello, G.

AU - Mattioli, G.

PY - 2019/1/1

Y1 - 2019/1/1

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