{"title":"聚焦乳糜腹水：一个大容量单中心左侧结直肠癌腹腔镜/机器人主动脉旁淋巴结切除术后值得注意的并发症。","authors":"Y Sun, Z Tang, X Wang, Z Xu, Y Huang, P Chi","doi":"10.1007/s10151-025-03120-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the incidence, severity, and treatment modalities of chylous ascites after laparoscopic/robotic para-aortic lymph node (PALN) dissection for left-sided colorectal cancer (CRC).</p><p><strong>Methods: </strong>A cohort of 143 patients who underwent laparoscopic PALN dissection for left-sided CRC were included. The least absolute shrinkage and selection operator (LASSO) and logistic regression analysis were performed to identify risk factors for the occurrence of chylous ascites.</p><p><strong>Results: </strong>Chylous ascites occurred in 27 (18.8%) patients. Multivariate logistic regression analysis demonstrated that prognostic nutritional index (PNI ≤ 46, OR = 3.18, P = 0.03), use of indocyanine green (ICG) fluorescence imaging (OR = 2.92, P = 0.04), and number of total retrieved lymph nodes (LNs) > 25 (OR = 5.41, P = 0.01) were independently correlated with the occurrence of chylous ascites. A nomogram predicting postoperative chylous ascites was developed, with a C-index of 0.75. Based on the grading system, 63.0% (17/27) were classified as Grade A, 22.2% (6/27) as Grade B, and 14.8% (4/27) as Grade C. The use of ICG fluorescence during surgery and the number of total retrieved PALNs were correlated with prolonged resolution (Grade B/C) of chylous ascites (P = 0.02 and P = 0.04).</p><p><strong>Conclusions: </strong>Postoperative chylous ascites represents a common and significant complication after laparoscopic/robotic PALN dissection for CRC surgery. PNI ≤ 46, ICG fluorescence imaging guidance, and total LN retrieval are independent risk factors. The use of ICG fluorescence during surgery and total retrieved PALNs are correlated with the prolonged resolution of chylous ascites. Further study is needed to validate these findings.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"78"},"PeriodicalIF":2.9000,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889067/pdf/","citationCount":"0","resultStr":"{\"title\":\"Focusing on chylous ascites: a noteworthy complication after laparoscopic/robotic para-aortic lymphadenectomy in left-sided colorectal cancer in a high-volume single center.\",\"authors\":\"Y Sun, Z Tang, X Wang, Z Xu, Y Huang, P Chi\",\"doi\":\"10.1007/s10151-025-03120-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This study aimed to evaluate the incidence, severity, and treatment modalities of chylous ascites after laparoscopic/robotic para-aortic lymph node (PALN) dissection for left-sided colorectal cancer (CRC).</p><p><strong>Methods: </strong>A cohort of 143 patients who underwent laparoscopic PALN dissection for left-sided CRC were included. The least absolute shrinkage and selection operator (LASSO) and logistic regression analysis were performed to identify risk factors for the occurrence of chylous ascites.</p><p><strong>Results: </strong>Chylous ascites occurred in 27 (18.8%) patients. Multivariate logistic regression analysis demonstrated that prognostic nutritional index (PNI ≤ 46, OR = 3.18, P = 0.03), use of indocyanine green (ICG) fluorescence imaging (OR = 2.92, P = 0.04), and number of total retrieved lymph nodes (LNs) > 25 (OR = 5.41, P = 0.01) were independently correlated with the occurrence of chylous ascites. A nomogram predicting postoperative chylous ascites was developed, with a C-index of 0.75. Based on the grading system, 63.0% (17/27) were classified as Grade A, 22.2% (6/27) as Grade B, and 14.8% (4/27) as Grade C. The use of ICG fluorescence during surgery and the number of total retrieved PALNs were correlated with prolonged resolution (Grade B/C) of chylous ascites (P = 0.02 and P = 0.04).</p><p><strong>Conclusions: </strong>Postoperative chylous ascites represents a common and significant complication after laparoscopic/robotic PALN dissection for CRC surgery. PNI ≤ 46, ICG fluorescence imaging guidance, and total LN retrieval are independent risk factors. The use of ICG fluorescence during surgery and total retrieved PALNs are correlated with the prolonged resolution of chylous ascites. Further study is needed to validate these findings.</p>\",\"PeriodicalId\":51192,\"journal\":{\"name\":\"Techniques in Coloproctology\",\"volume\":\"29 1\",\"pages\":\"78\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-03-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889067/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Techniques in Coloproctology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10151-025-03120-8\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques in Coloproctology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10151-025-03120-8","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：本研究旨在评估左侧结直肠癌（CRC）腹腔镜/机器人腹主动脉旁淋巴结（PALN）清扫术后乳糜腹水的发生率、严重程度和治疗方式。方法：143例左侧结直肠癌患者行腹腔镜PALN清扫术。采用最小绝对收缩和选择算子（LASSO）和logistic回归分析来确定乳糜腹水发生的危险因素。结果：乳糜性腹水27例（18.8%）。多因素logistic回归分析显示，预后营养指数（PNI≤46,OR = 3.18, P = 0.03）、使用吲哚青绿（ICG）荧光显像（OR = 2.92, P = 0.04）、总淋巴结清扫数（LNs） bbb25 （OR = 5.41, P = 0.01）与乳糜腹水的发生独立相关。建立预测术后乳糜腹水的nomogram， C-index为0.75。根据分级制度，63.0%（17/27）为A级，22.2%（6/27）为B级，14.8%（4/27）为C级。术中ICG荧光的使用和总回收paln数量与乳糜腹水的延长分辨率（B/C级）相关（P = 0.02和P = 0.04）。结论：术后乳糜腹水是腹腔镜/机器人PALN清扫结直肠癌手术后常见且重要的并发症。PNI≤46、ICG荧光成像引导、全LN恢复是独立危险因素。手术中ICG荧光的使用和总回收paln与乳糜腹水的延长溶解相关。需要进一步的研究来验证这些发现。
Focusing on chylous ascites: a noteworthy complication after laparoscopic/robotic para-aortic lymphadenectomy in left-sided colorectal cancer in a high-volume single center.
Background: This study aimed to evaluate the incidence, severity, and treatment modalities of chylous ascites after laparoscopic/robotic para-aortic lymph node (PALN) dissection for left-sided colorectal cancer (CRC).
Methods: A cohort of 143 patients who underwent laparoscopic PALN dissection for left-sided CRC were included. The least absolute shrinkage and selection operator (LASSO) and logistic regression analysis were performed to identify risk factors for the occurrence of chylous ascites.
Results: Chylous ascites occurred in 27 (18.8%) patients. Multivariate logistic regression analysis demonstrated that prognostic nutritional index (PNI ≤ 46, OR = 3.18, P = 0.03), use of indocyanine green (ICG) fluorescence imaging (OR = 2.92, P = 0.04), and number of total retrieved lymph nodes (LNs) > 25 (OR = 5.41, P = 0.01) were independently correlated with the occurrence of chylous ascites. A nomogram predicting postoperative chylous ascites was developed, with a C-index of 0.75. Based on the grading system, 63.0% (17/27) were classified as Grade A, 22.2% (6/27) as Grade B, and 14.8% (4/27) as Grade C. The use of ICG fluorescence during surgery and the number of total retrieved PALNs were correlated with prolonged resolution (Grade B/C) of chylous ascites (P = 0.02 and P = 0.04).
Conclusions: Postoperative chylous ascites represents a common and significant complication after laparoscopic/robotic PALN dissection for CRC surgery. PNI ≤ 46, ICG fluorescence imaging guidance, and total LN retrieval are independent risk factors. The use of ICG fluorescence during surgery and total retrieved PALNs are correlated with the prolonged resolution of chylous ascites. Further study is needed to validate these findings.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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