Case of the month from University of Melbourne, Australia: refractory chyle leak after retroperitoneal lymph node dissection with updated algorithm.

Abstract

Retroperitoneal lymph node dissection (RPLND) is an important part of multimodal therapy for node-positive germ cell malignancy [1-4]. However, due to wide heterogeneity in patient status, disease biology and tumour locations, RPLND can be challenging and risky [1]. One such risk is iatrogenic chylous ascites (CA; 8% of cases) [1]. CA is defined as accumulation of chyle, a lipid-rich lymph fluid in the peritoneal cavity [5]. Morbidity from intra-abdominal chyle extravasation includes delayed wound healing, malnutrition, electrolyte disturbances, and immunosuppression [2, 6]. This morbidity impairs postoperative recovery, delays adjuvant oncological therapy, and detrimentally affects quality of life [2, 4]. Limited reliable data exist to describe the management of this complex condition [1]. We outline a difficult case and then review the literature for treatment strategies and propose a contemporary management algorithm for refractory post-RPLND CA.