Chylous ascites in colorectal surgery: A systematic review

Table 1 A summary of all the reported cases of chylous ascites in colorectal surgery

Ref.	No. of Cases	Age/gender	Diagnosis	Type of surgery	Level of lymphadenectomy
Giovannini et al[22], Italy, 2005	1	69/M	MA	Lap AR	D3
Chan et al[30], Malaysia, 2006	1	32/M	MA	AR	N/A
Chi et al[21], China, 2006	10	N/A	MA	Lap LAR (n = 3); Open LAR (n = 7)	N/A
Giovannini et al[34], Italy, 2008	1	60/M	MA	Laparotomy (previous endoscopic removal of R colon polyp)	Lymphadenectomy (not specified)
Lu et al[35], China, 2010	46	58.7 (mean) (24-83); M (n = 27) / F (n = 20)	MA	Laparoscopic (n = 28); Open (n = 18); R Hemicolectomy (n = 16); L Hemicolectomy (n = 7); AR (n = 23)	N/A
Sun et al[36], China, 2012	46	57.4 (mean); M (n = 29)/F (n = 17)	MA	R Hemicolectomy (n = 30); L Hemicolectomy (n = 16)	D3
Feng et al[12], China, 2012	1	N/A	MA	Lap R Hemicolectomy	CME
Nishigori et al[1], Japan, 2012	9	Age Range 49-80; M (n = 4)/F (n = 5)	MA	Open R Hemicolectomy (n = 5); Open HAR (n = 1); Open sigmoidectomy (n = 1); Lap AR (n = 1); Lap HAR (n = 1)	D2/D3
Nakayama et al[31], Japan, 2012	1	67/M	MA	LAR	Para-aortic lymphadenectomy
Bartolini et al[32], Italy, 2013	3	43/F; 78/F; 85/F	MA	Lap AR	N/A
Galketiya et al[23], Australia, 2013	1	76/F	MA	AR	N/A
Matsumura et al[24], Japan, 2013	2	64/F; 80/M	MA	Lap R hemicolectomy (n = 1); Lap HAR (n = 1)	D2; D3
Matsuda et al[2], Japan, 2013	9	Age Range 55-80; M (n = 7)/F (n = 2)	MA	Lap R hemicolectomy (n = 4); Lap AR (n = 5)	D3
Han et al[14], China, 2013	4	N/A	MA	Lap assisted radical R hemicolectomy (n = 4)	D3
Shin et al[15], Korea, 2014	2	N/A	MA	Lap Colectomy	D3 and CME
Soyer et al[25], Turkey, 2014	1	76/F	MA	Open R Hemicolectomy	D3
Inada et al[16], Japan, 2014	1	N/A	MA	Lap APR	D2
Ha et al[26], Korea, 2015	1	65/M	MA	Lap AR	D2
Lee et al[17], Korea, 2016	138	65.0 ± 11.8	MA	Open (n = 6); Laparoscopic (n =132); R Hemicolectomy (n = 27); L Hemicolectomy (n = 4); AR (n = 40); LAR (n = 63); APR (2); Others (2)	D3
Korkolis et al[27], Greece, 2017	1	44/M	MA	Lap LAR	D2
Wang et al[6], China, 2017	22	N/A	MA	Lap R hemicolectomy	CME
Pascual et al[33], Spain, 2017	1	57/F	B	Lap sigmoidectomy	N/A
Owada et al[28], Japan, 2018	1	60s/M	MA	Lap sigmoidectomy	D3
Fujii et al[9], Japan, 2018	11	N/A	MA	AR (Lap/Open)	D2
Shimajiri et al[29], Japan, 2018	1	31/M	MA	Lap descending colectomy	D3
An et al[19], Korea, 2018	6; 9	N/A; N/A	MA; MA	Lap R hemicolectomy; Lap R hemicolectomy	CME; Non-CME
Suzuki et al[20], Japan, 2019	1	N/A	MA	N/A	N/A
Lee et al[10], Korea, 2020	50	N/A	MA	Lap R hemicolectomy	D3/D4

MA: Malignant HAR: High anterior resection; LAR: Low anterior resection; APR: Abdominoperineal resection; CME: Complete mesocolic resection.

Table 2 The reported type of equipment used for dissection during colorectal surgery

Ref.	Type of equipment used
Giovannini et al[22]	Harmonic scalpel
Giovannini et al[34]	Wet bipolar forceps
Nishigori et al[1]	Electrosurgical knife and ultrasonically activated scalpel
Matsumura et al[24]	Ultrasound-coagulation and electrical scalpel
Matsuda et al[2]	Laparoscopic coagulating shears and hemoclips
Baek et al[13]	Electrosurgical bipolar vessel sealer (Ligasure) or vascular clips
Soyer et al[25]	Ligasure
Lee et al[17]	Electrothermal bipolar vessel sealer or ultrasonic coagulating shears
Korkolis et al[27]	Ultrasonic sealing scalpel
Owada et al[28]	Electric surgical knife and ultrasonically activated devise
Lee et al[10]	Endoshears

Table 3 Definitions of chylous ascites in different studies

Ref.	Definition
Matsuda et al[2]	White milky fluid in the drainage that contained high level so triglycerides (> 150 mg/dL)
Nishigori et al[1]	Non-infectious milky fluid in the drainage tubes
Baek et al[13]	Non-infectious extravasation of milky or creamy peritoneal fluid in the drain tubes with a volume of > 200 mL/d and a triglyceride level > 100 mg/dL
Lee et al[20]	Presence of noninfectious milky or creamy peritoneal fluid in the drainage tubes, at a volume of > 200 mL/d

Table 4 A summary of the different non-operative management employed for management of chylous ascites after colorectal surgery

No.	Initial management	Number of cases	Successful	Surgery	Ref.
1	No treatment (“Healed spontaneously”)	53	Yes	No	[1,10,24]
2	Fasting only	14	Yes	No	[1,2]
3	Fasting + TPN	1	Yes	No	[32]
4	Fasting + TPN + Octreotide/somatostatin	103	Yes	No	[21,25,34-36]
5	Failed (fasting + TPN + somatostatin) + surgery	1	No	Yes	[35]
6	Octreotide	1	Yes	No	[13]
6	MCT only	9	Yes	No	[1,13]
7	MCT + TPN/fasting	1	Yes	No	[23]
8	Fat-free diet only	1	Yes	No	[31]
9	Low fat diet only	5	Yes	No	[24,28,32]
10	Low fat diet + somatostatin	1	Yes	No	[27]
11	Low fat diet + MCT + Fasting/TPN/somatostatin	1	No	Yes	[26]
12	No treatment-discharged homeParacentesis + fasting/TPN + low fat dietParacentesis + TPN + somatostatinMCT	1	No	Yes	[29]
13	“Conservative therapy” only	160	Yes	No	[6,17]
14	Failed “Conservative therapy” + surgery	1	No	Yes	[33]
15	Not available	72	N/A	N/A	[9,12-16,19,20,30]

TPN: Total parenteral nutrition; MCT: Medium chain triglyceride; N/A: Not applicable.

Table 5 Risk factors identified for the occurrence of chylous ascites in colorectal surgery

Ref.	Risk factor	Not risk factor
Lu et al[35], 2010	Right colectomy	-
Sun et al[36], 2012	Tumour size; Tumour location; Number of lymph nodes harvested harvested	-
Nishigori et al[1], 2012	Tumour location; Tumours fed by SMA; D3 Dissection	-
Matsuda et al[2], 2013	-	Blood loss; Operative time; Extent of lymph node dissection; Number of lymph nodes harvested; Region of lymph node dissection
Baek et al[13], 2013	Older age; Right colectomy; Transverse segmental colectomy; Shorter operative time; Lower blood loss; Operator difference	-
Lee et al[17], 2016	Shorter operative time; Positive lymph node metastasis; Number of lymph node harvested; Tumour size	Tumour location; Type of surgery

SMA: Superior mesenteric artery.