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. 2025 Feb 10;17(4):592.
doi: 10.3390/cancers17040592.

Multidisciplinary Treatment for Lymphorrhea and Chylorrhea Following Lymph Node Dissection for Genitourinary Cancer

Naoto Kamiya  1 , Takahide Noro  1 , Taro Okazaki  1 , Naoki Ishitsuka  1 , Yuta Suzuki  1 , Shota Iijima  1 , Yuka Sugizaki  1 , Takatoshi Somoto  1 , Ryo Oka  1 , Takanobu Utsumi  1 , Takumi Endo  1 , Shusuke Kasuya  2 , Nobuyuki Hiruta  3 , Hiroyoshi Suzuki  1
Affiliations

Multidisciplinary Treatment for Lymphorrhea and Chylorrhea Following Lymph Node Dissection for Genitourinary Cancer

Naoto Kamiya et al. Cancers (Basel). .

Abstract

Background: Lymph node dissection (LND) is often performed in genitourinary cancer to improve accurate staging. However, the resultant lymphatic damage often leads to postoperative lymphorrhea and chylorrhea. Further, since lymphatic fluid lacks platelets, it has very few clotting factors, and it is often difficult to treat postoperative lymphatic leakage. Treatments for lymphorrhea include conservative treatment (e.g., fasting, total parenteral nutrition, and drug therapy), interventional radiology (IR) and surgical treatment. However, there is no guideline of refractory lymphorrhea, and no clear criteria for switching to the next treatment.

Methods: We reviewed the records of 28 patients at Toho University Sakura Medical Center with postoperative lymphorrhea or chylorrhea after LND that did not improve with conservative treatment. Based on this analysis, we partially revised the treatment algorithm for lymphorrhea developed by Rose et al. Results: The cases consisted of 26 men and two women, aged 65.0 ± 9.9 years. The mean number of lymph nodes removed was 25.3 ± 15.0. Octreotide was administered in 27 patients, lymphangiography was performed in three patients, and lymphatic embolization was performed in two patients. The mean duration of octreotide administration was 9.7 ± 6.1 days, and the mean dose was 211.1 µg/day. The treatment success rates with octreotide and IR were 78.6% and 100%, respectively. The mean duration of drain placement after surgery for primary cancer was 18.3 ± 14.3 days.

Conclusions: Patients with lymphorrhea and chylorrhea should be initially treated conservatively, with IR performed if conservative treatment is unsuccessful. Surgical treatment should be a last resort.

Keywords: chylorrhea; interventional radiology; intranodal lymphangiography; lymph node dissection; lymphatic embolization; lymphorrhea; octreotide.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Intranodal lymphangiography for postoperative lymphorrhea.
Figure 2
Figure 2
Treatment methods for postoperative lymphorrhea and chylorrhea. pts: patients.
Figure 3
Figure 3
Treatment algorithm for postoperative lymphorrhea and chylorrhea (partial revision of the algorithm proposed by Rose et al. [6]). IL: intranodal lymphangiography.
See this image and copyright information in PMC

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