Treatment of Chylous Ascites with Peritoneovenous Shunt (Denver Shunt) following Retroperitoneal Lymph Node Dissection in Patients with Urological Malignancies: Update of Efficacy and Predictors of Complications
- 5 May 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 204 (4), 818-823
- https://doi.org/10.1097/ju.0000000000001121
Abstract
Purpose: We investigated the efficacy and analyzed the complication risk factors of peritoneovenous shunt in treating refractory chylous ascites following retroperitoneal lymph node dissection in patients with urological malignancies. Materials and Methods: From April 2001 to March 2019 all patients with refractory chylous ascites after retroperitoneal lymph node dissection treated with peritoneovenous shunt were reviewed. Demographic characteristics, technical success, efficacy, patency period and complications were studied. Univariate and multivariate logistic regression analysis was performed to identify predictors of complications. Results: Twenty patients were included in this study. Testicular cancer was the most common malignancy (85%). The mean number of days from surgery to detection of chylous ascites was 21 days (SD 15, range 4 to 65). Ascites permanently resolved after peritoneovenous shunt in 18 patients (90%), leading to shunt removal in 17 patients (85%) between 46 and 481 days (mean 162, SD 141). The mean serum albumin level increased 24% after shunt placement (mean 3.0±0.6 gm/dl before, 3.9±0.8 gm/dl after, p <0.05). The most common complication was occlusion (30%). Relative risk of complications increased significantly when shunt placement was more than 70 days after surgery and in patients with more than 5 paracenteses before peritoneovenous shunt placement (AR 0.71% vs 0.25%, RR 2.9, p <0.048 and AR 0.6% vs 0.125%, RR 4.8, p <0.04, respectively). Conclusions: Peritoneovenous shunt permanently treated chylous ascites in 90% of patients after retroperitoneal lymph node dissection. Peritoneovenous shunt was removed in 85% of patients. Shunt placement is an effective and safe treatment option for refractory chylous ascites. These patients might benefit from earlier intervention, after 4 to 6 weeks of conservative management as opposed to 2 to 3 months.Keywords
This publication has 27 references indexed in Scilit:
- Percutaneous Placement and Management of Peritoneovenous ShuntsSeminars in Interventional Radiology, 2012
- Guidelines for the diagnosis and management of disseminated intravascular coagulationBritish Journal of Haematology, 2009
- Percutaneous Peritoneovenous Shunt for Treatment of Refractory AscitesJournal of Vascular and Interventional Radiology, 2008
- Malignant ascites: Systematic review and guideline for treatmentEuropean Journal of Cancer, 2006
- THE DIAGNOSIS AND MANAGEMENT OF POSTOPERATIVE CHYLOUS ASCITESJournal of Urology, 2002
- Chylous ascites after oncological abdominal surgery: incidence and treatmentEuropean Journal of Surgical Oncology, 2001
- Management of chyloperitoneum after abdominal aortic surgeryThe American Journal of Surgery, 1993
- Chylous ascites following retroperitoneal lymph node dissection successfully treated with peritoneovenous shuntJournal of Surgical Oncology, 1987
- Morbidity and mortality after peritoneovenous shunt surgery for refractory ascites.Gut, 1985
- Chylous Ascites after Retroperitoneal Lymphadenectomy: Successful Management with Peritoneovenous ShuntUrologia Internationalis, 1984