Four Cases of Chylous Ascites following Robotic Gynecologic Oncological Surgery

Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels. The most common causes of chylous ascites are therapeutic interventions and trauma. In this report, we present four cases of chylous ascites following robot-assisted surgery for endometrial staging and the treatment strategies that we used. After retroperitoneal lymph node dissection, leaving a drain is very useful in diagnosing chylous ascites and observing its resolution; furthermore, the use of octreotide in conjunction with TPN appears to be an efficient treatment modality for chylous ascites and should be considered before any invasive intervention. 1. Introduction Chylous ascites is an uncommon form of ascites characterized by milky-appearing fluid caused by blocked or disrupted lymph flow through chyle-transporting vessels. The most common causes of chylous ascites are therapeutic interventions and trauma. The increase in the incidence of chylous ascites is attributed to the longer survival of patients with cancer and more aggressive abdominal, retroperitoneal, and cardiothoracic interventions, despite the lack of recent large studies [1]. The recommended treatment options for chylous ascites are therapeutic paracentesis, dietary control with a high-protein, low-fat, medium-chain triglyceride- (MCT-) based diet, total parenteral nutrition (TPN), somatostatin, and surgical intervention [2]. In this study, we present four cases of chylous ascites following robot-assisted surgery for gynecologic malignancies and their management. 2. Case Presentations Case 1. A 58-year-old woman, gravida 6, para 6, with a two-month history of vaginal bleeding was referred to our hospital. Transvaginal ultrasonography revealed a solid 12 × 17？mm lesion in the endometrial cavity. The patient was diagnosed with a carcinosarcoma with heterologous elements following an endometrial biopsy. The patient underwent robot-assisted endometrial staging via the da Vinci S surgical system (Intuitive Surgical Sunnyvale, CA). The procedure included hysterectomy, bilateral salpingo-oophorectomy (BSO), and pelvic and paraaortic lymph node dissection (PPLN) up to renal vein. The patient was discharged on the third postoperative day without any complication. The final pathological finding was a stage IB grade III carcinosarcoma with heterologous elements. A total of 35 removed lymph nodes were free of disease. The patient was readmitted to the hospital two weeks after surgery due to abdominal distension, nausea, dyspnea, and