Incidence and Risk Factors for Chyle Leaks after Neuroblastic Tumor Resection: A Systematic Review of Published Studies

Abstract

<p>Background <br></p><p>Chyle leakage / ascites after surgical resection of neuroblastic tumors may delay the start of chemotherapy and worsen prognosis. Previous studies have reported a highly variable incidence and risk factors remain largely unknown. This study aims to analyze the true incidence of chyle leaks and ascites and seeks to identify risk factors and optimal treatment strategies. <br></p><p>Methods <br></p><p>Medline/Embase databases were searched according to PRISMA guidelines. Literature reviews, case reports, and non-English papers were excluded. Data were extracted independently following paper selection by 2 authors. <br></p><p>Results <br></p><p>The final analysis yielded 15 studies with N = 1468 patients. Chylous ascites was recorded postoperatively in 171 patients (12%). Most patients experiencing chyle leaks were successfully treated conservatively with drainage, bowel rest, parenteral nutrition and octreotide with variable combinations of these treatment options. 7 / 171 (4%) patients required operative exploration to control troublesome persistent chyle leaks. In risk factor analysis, higher tumor stage was significantly associated with the risk of chyle leak (P<0.0001) whereas no correlation was observed with adrenal vs non-adrenal tumor site location. Risk factor analysis further demonstrated higher tumor stage was significantly associated with the risk of chyle leak (P<0.0001) whereas no correlation was observed with adrenal vs non-adrenal tumor location, INRG risk groups and tumor laterality. <br></p><p>Conclusion <br></p><p>Chyle leakage after surgery for neuroblastic tumors is a common morbid complication occurring in some 12% of patients. Higher INSS tumor stage portends greater risk(s). Conservative therapy strategies appear successful in the majority of cases. To avert this complication meticulous mesenteric lymphatic ligation is recommended especially for those patients with higher tumor stage(s) requiring extensive radical surgery including retroperitoneal lymph node resection. <br></p><p>Level of Evidence <br></p><p>III</p><p>Keywords<br>chyle leak; chylous ascites; neuroblastoma; radical resection; surgical oncology<br></p><p>Abbreviations<br>INSS, International Neuroblastoma Staging System<br></p>