Octreotide therapy for the management of refractory chylous ascites after a staging operation for endometrial adenocarcinoma

Abstract

Chylous ascites after para-aortic lymphadenectomy is caused by a rupture in the retroperitoneal lymphatic channels. The incidence of postoperative chylous ascites is increasing as para-aortic lymphadenectomy for the management of gynecologic malignancies becomes more common. However, management of this condition remains unsatisfactory because some patients do not respond to conservative methods and have to undergo surgical intervention, even though they may be malnourished and immunosuppressed. We report the case of a patient who underwent a standard staging operation for endometrial cancer and experienced a large amount of lymphatic leakage, in spite of treatment with total parenteral nutrition and a low-fat diet for over 40 days. As a step-up approach, octreotide, a somatostatin analog, was added and the disease resolved completely. This case demonstrated that octreotide therapy is highly effective in refractory cases of chylous ascites where a large amount of leakage is observed and cases that are otherwise indicated for surgical intervention.