Abstract
Lymphatic complications are rare, but well-known phenomena, and have been described by many researchers. However, many diagnoses of lymphatic complications are found confusing due to different definition. A literature search in Pubmed was performed for studies postoperative lympatic complications. These complications divided into two parts: lymphatic leakage and lymphatic stasis. This review is about lymphatic leakage, especially, postoperative lymphatic leakage due to the injury of lymphatic channels in surgical procedures. According to polytrophic consequences, many types of postoperative lymphatic leakage have been presented, including lymph ascites, lymphocele, lymphorrhea, lymphatic fistula, chylous ascites, chylothorax, chyloretroperitoneum and chylorrhea. In this review, we focus on the definition, incidence and treatment about most of these forms of lymphatic complications to depict a comprehensive view of postoperative lymphatic leakage. We hold the idea that the method of treatment should be individual and personal according to manifestation and tolerance of patient. Meanwhile, conservative treatment is suitable and should be considered first.
Highlights
Many surgical procedures may injure lymphatic channels unexpectedly such as lymph node dissections, transplantations and vessels reconstructions, and will lead to iatrogenic lymphatic leakage
We focus on the definition, incidence and treatment about most of these forms of lymphatic complications to depict a comprehensive view of postoperative lymphatic leakage
According to the anatomic datum, half of the cases don’t have cisterna chyli, as it is replaced by a variable lymphatic plexus [3]. It exists in paired form, right and left thoracic ducts during the development of the embryo, but the only certain portion will develop into an adult thoracic duct
Summary
Lymphatic circulation can drain proteins and excess interstitial fluid back to the systemic circulation, regulate the immune responses by both cellular and humoral mechanisms, and absorb lipids from the intestine [1]. Besides the types of postoperative lymphatic leakage mentioned above, there are some special forms of lymphatic leakage such as chylous ascites (chyloperitoneum), chyloretroperitoneum, chylothorax and chylorrhea This classification depends on the following reasons: 1 Lymph fluid is clear or straw-colored ascites similar to the serum of patients [13]. The www.impactjournals.com/oncotarget symptoms of chylous ascites usually occur at average 4.1 days after surgery due to the dietary intake at postoperation day (POD) 2 It usually forms as a result of surgical trauma of the thoracic duct, cisterna chyli or their major tributaries [34, 59]. Drainage can relieve symptoms by decreasing the accumulation of lymphatic fluid It is frequently applied in most of lymphatic complications, such as lymph ascites, lymphocele, chylous ascites, and chylothorax [8, 16, 23, 26]. Since laparoscopic surgeries seem to have a high incidence of lymphatic leakage, it is necessary to coagulate the lymphatic channels adequately as a preventive measure, even if lymphatic leakage is not found [10, 31, 57]
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