Abstract

Objective: Gastric cancer is the fifth most prevalent cancer and the third leading cause of cancer-related deaths. After gastric cancer surgery, 1.99% of patients developed chylous leaks after dissections of D1 and D2 and 6.3% after dissections of D3 and D4. The milky discharge from the abdominal drains following enteral feeding indicates chylous leak. After cancer surgery, diagnosis and treatment of chylous leaks are crucial. This study aimed to guide the treatment of chylous leaks.

Methods: A total of 213 patients (147 men, 66 women) underwent D2 lymph node dissection after total or subtotal gastric resection. Age, gender, tumor location, type of surgery, number of resected lymph nodes, metastatic lymph nodes, day of lymphatic discharge, diagnosis of chylous leak, treatment, morbidity, mortality, fistula closure, and length of hospital stay were evaluated.

Results: The mean number of lymph nodes removed during surgery was 39 (16-87). Thirteen patients developed chylous leaks, with an average detection time of 5 days (3-7). At the outset of the study, total parenteral nutrition was administered to patients with chylous leaks. The patients were then given a low-fat diet with medium-chain triglycerides (MCT).

Conclusion: The Tg was 230-3497 mg/dL in our study. The chylous leak group had more lymph nodes dissected than the non-chylous leak group, but the difference was not statistically significant. Chylous leaks are associated with preoperative anemia, hypoalbuminemia, and lymph node resection. After drain output dropped below 300 cc/day, a middle-chain triglyceride diet was administered. None of our patients underwent surgery due to chylous leaks, and we can confidently state that patients with chylous leaks can be followed up with the MCT diet.