Management of Lymphatic Leaks After Retroperitoneal Lymph-Node Dissections in Gynecologic Cancers

Objective: Lymphatic-channel leakage after retroperitoneal lymph-node dissection (RPLND) includes lymphatic ascites or chylous ascites. Given that the presentation is rare and that only limited literature is available, no guidelines or treatment guides are available for its management. This study aimed to help develop a management strategy for this rare condition. Materials and Methods: This retrospective study took place from January 2014 to January 2020. Case records of 255 patients were reviewed from a prospectively maintained computerized database of patients who underwent RPLND as a part of surgical management for ovarian and endometrial carcinomas and who had postoperative lymphatic-channel leaks. Demographic profile, disease incidence, clinical details, diagnoses, stages, and treatment modalities were analyzed. Results: A total of 11 patients had lymphatic leaks postoperatively. Four patients had chylous ascites, and 7 patients had lymphatic ascites. All patients were managed conservatively; none of them required surgery. There was no perioperative mortality in these patients. Conclusions: Lymphatic leak is a known, but uncommon, complication after RPLND, leading to a prolonged hospital stay and increased risk of infection. The majority of these leaks can be managed conservatively. A backup surgical plan should be in place if the leak persists. (J GYNECOL SURG 38:133)