Treatment and prevention of lymphorrhea after radical gastrectomy of gastric cancer.

摘要

PURPOSE: Lymphorrhea is an uncommon complication of abdominal surgery. Here, we retrospectively investigate the treatment and prevention of lymphorrhea after radical gastrectomy. METHODS: From January 1995 to January 2007, a total of 1,596 patients who underwent surgery for gastric cancer were investigated. According to the AJCC cancer stage manual, tumor stages of 693 (43.4%) cases were T1 or T2 and 903 (56.6%) cases were T3 or T4. A total of 1,104 (69.2%) patients received grade D1 lymphadenectomy or grade D2, and 492 (30.8%) patients received grade D3 or D4. Ligation was used during the lymphadenectomy in 829 (51.9%) patients, and the electrotome cautery was used in 767 (48.1%) patients. Patients diagnosed of lymphorrhea were treated with total parenteral nutrition (TPN) alone before 2001, and with TPN plus octreotide after 2001. RESULTS: The incidence of lymphorrhea of patients with D1-2 lymphadenectomy was much lower than those with D3-4 lymphadenectomy (P < 0.01). For patients whose lymphatic vessels were ligated during the operation, the incidence of lymphorrhea was much lower than those lymphatic vessels were electrically cauterized (P < 0.01). No significant difference of incidence of lymphorrhea could be found between patients with T1-2 and T3-4 tumor stages (P > 0.05). Octreotide or TPN administration can reduce the quantity and duration of lymphorrhea,and the combination of Octreotide and TPN has a more significant effect on lymphorrhea than TPN alone (P < 0.01). CONCLUSION: The major cause of lymphorrhea following radical gastrectomy was the inappropriate management of lymphadenectomy. Avoiding an extensive lymphadenectomy at surgery and ligating the disrupted lymph vessels would reduce the incidence of lymphorrhea. The combination of Octreotide and TPN is an effective therapeutic modality for lymphorrhea.