Advances in the diagnosis and management of chyle leak following gastric cancer surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIN Zhongjun ^1,2,3 ,  ZANG Lu ^1,2,3

1. Department of General Surgery/Gastrointestinal Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai200025, P. R. China;
2. Shanghai Minimally Invasive Surgery Center, Shanghai 200025, P. R. China;
3. Shanghai Institute of Digestive Surgery, Shanghai 200025, P. R. China;

Corresponding?author：

ZANG Lu, Email: zanglu@yeah.net

Keywords：

gastric cancer; chyle leak; postoperative complication; lymphadenectomy

DOI：

10.7507/1007-9424.202604102

Video：

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Objective To review the advances in the pathogenesis, diagnostic modalities, treatment strategies, and preventive measures of chyle leak following gastric cancer surgery, aiming to provide an evidence-based reference for clinical practice. Methods Recent domestic and international studies concerning the risk factors and management of postoperative chyle leak in gastric cancer were retrieved and systematically analyzed. Results Postoperative chyle leak is primarily caused by extensive lymphadenectomy. Advanced age, obesity, and extended lymph node dissection are identified as high-risk factors. The diagnosis can be confirmed by analyzing the characteristics and triglyceride concentration of the drainage fluid, while imaging techniques facilitate the precise localization of the leak. The majority of patients can be cured with conservative management, encompassing fasting, a medium-chain triglyceride diet, and somatostatin therapy. For high-output or refractory cases, interventional radiology or surgical treatments are indicated. Conclusions The management of post-gastrectomy chyle leak should adhere to the comprehensive principles of “perioperative prevention, early recognition, and standardized intervention”. Future multicenter randomized controlled trials and the development of risk prediction models are warranted to provide high-level evidence for individualized clinical decision-making and further improve patients’ outcomes.

Citation： LIN Zhongjun, ZANG Lu. Advances in the diagnosis and management of chyle leak following gastric cancer surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(5): 648-653. doi: 10.7507/1007-9424.202604102 Copy

1.	李茁鈺, 劉凱, 張維漢, 等. 全球及中國胃癌的流行病學特點及趨勢: 2018–2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(10): 1236-1245.
2.	Lin SZ, Tong HF, Ni ZL, et al. Treatment and prevention of lymphorrhea after radical gastrectomy of gastric cancer. J Cancer Res Clin Oncol, 2009, 135(4): 613-616.
3.	韋明光, 王楠, 吳濤, 等. 食管空腸overlap與π形吻合術后短期療效及患者生活質量的對比研究. 中國普通外科雜志, 2019, 28(4): 407-416.
4.	王秀茹. 乳糜性腹水247例國內文獻分析. 臨床薈萃, 2009, 24(6): 513-515.
5.	Leibovitch I, Mor Y, Golomb J, et al. The diagnosis and management of postoperative chylous ascites. J Urol, 2002, 167(2 Pt 1): 449-457.
6.	Bhardwaj R, Vaziri H, Gautam A, et al. Chylous ascites: a review of pathogenesis, diagnosis and treatment. J Clin Transl Hepatol, 2018, 6(1): 105-113.
7.	崔耀夫, 董永紅. 進展期胃癌腹主動脈旁淋巴結清掃對患者生存預后的影響. 中華腫瘤防治雜志, 2020, 27(S1): 94, 96.
8.	Ilhan E, Demir U, Alemdar A, et al. Management of high-output chylous ascites after D2-lymphadenectomy in patients with gastric cancer: a multi-center study. J Gastrointest Oncol, 2016, 7(3): 420-425.
9.	鄧靖宇, 任寶清. 胃癌淋巴結清掃的臨床爭議和研究思緒. 中華胃腸外科雜志, 2022, 25(4): 361-366.
10.	Laterre PF, Dugernier T, Reynaert MS. Chylous ascites: diagnosis, causes and treatment. Acta Gastroenterol Belg, 2000, 63(3): 260-263.
11.	Degiuli M, De Manzoni G, Di Leo A, et al. Gastric cancer: current status of lymph node dissection. World J Gastroenterol, 2016, 22(10): 2875-2893.
12.	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2025 (7th edition). Gastric Cancer, 2026, 29(2): 271-299.
13.	Dong YP, Deng JY. Advances in para-aortic nodal dissection in gastric cancer surgery: a review of research progress over the last decade. World J Clin Cases, 2020, 8(13): 2703-2716.
14.	中國抗癌協會腹膜腫瘤專業委員會. 中國腫瘤整合診治指南: 腹膜腫瘤(胃腸腫瘤部分). 中華胃腸外科雜志, 2023, 26(2): 111-120.
15.	Noji T, Narasaki H, Ebihara Y, et al. Near infrared fluorescence light imaging for lymphatic flow toward para-aortic lymph node from the Calot’s triangle: a prospective exploratory study. Photodiagnosis Photodyn Ther, 2018, 24: 274-279.
16.	Griniatsos J, Dimitriou N, Kyriaki D, et al. Chylorrhea complicating D2+a gastrectomy: review of the literature and clarification of terminology apropos one case. Chin Med J (Engl), 2010, 123(16): 2279-2283.
17.	趙海遠, 劉剛, 李陽, 等. 體脂率作為預測胃癌手術后并發癥和生存率新指標的研究探討. 中國腫瘤臨床, 2023, 50(16): 821-828.
18.	陳豪, 余佩武, 黃昌明, 等. 腹腔鏡遠端胃癌D2根治術治療局部進展期胃癌10年預后及影響因素分析: 基于CLASS隊列的全國多中心研究. 中華消化外科雜志, 2022, 21(3): 362-374.
19.	Duman MG, Alemdar A. Chylous leak management in gastric cancer patients after D2 dissection. Anatol J Gen Med Res, 2025, 35(2): 96-100.
20.	Duletzke NT, Kiraly LN, Martindale RG. Chylothorax and chylous ascites: overview, management, and nutrition. Nutr Clin Pract, 2023, 38(3): 557-563.
21.	范巍, 段永利, 敷巖, 等. CT淋巴管造影成像的技術要點和成像參數. CT理論與應用研究, 2022, 31(4): 499-504.
22.	洪斯浩, 郝林, 李振亞, 等. 結內淋巴管造影在乳糜尿患者診治中的應用. 影像診斷與介入放射學, 2023, 32(6): 422-428.
23.	Litchinko A, Monnard E, Tappero C, et al. Role of Lipiodol^? lymphangiography in the diagnosis and management of post-operative chylous ascites. Front Radiol, 2025, 5: 1537744. doi: 10.3389/fradi.2025.1537744.
24.	Matsumoto T, Yamagami T, Kato T, et al. The effectiveness of lymphangiography as a treatment method for various chyle leakages. Br J Radiol, 2009, 82(976): 286-290.
25.	Sommer CM, Pieper CC, Itkin M, et al. Conventional lymphangiography (CL) in the management of postoperative lymphatic leakage (PLL): a systematic review. Rofo, 2020, 192(11): 1025-1035.
26.	Chavhan GB, Amaral JG, Temple M, et al. MR lymphangiography in children: technique and potential applications. Radiographics, 2017, 37(6): 1775-1790.
27.	Pieper CC, Feisst A, Schild HH. Contrast-enhanced interstitial transpedal MR lymphangiography for thoracic chylous effusions. Radiology, 2020, 295(2): 458-466.
28.	黃秋雨, 王帥, 何悅, 等. 口腔頜面部惡性腫瘤頸淋巴清掃術后乳糜漏臨床營養管理專家共識. 中國口腔頜面外科雜志, 2025, 23(5): 425-433.
29.	楊孝清, 邱維誠, 陳中元. 下段食管癌切除術后經鼻和經皮穿刺放置空腸營養管的臨床轉歸. 實用臨床醫藥雜志, 2013, 17(1): 34-36, 40.
30.	Ablan CJ, Littooy FN, Freeark RJ. Postoperative chylous ascites: diagnosis and treatment. A series report and literature review. Arch Surg, 1990, 125(2): 270-273.
31.	Kong PF, Xu YH, Lai ZH, et al. Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery. World J Gastroenterol, 2022, 28(42): 6056-6067.
32.	Miserachs M, Lurz E, Levman A, et al. Diagnosis, outcome, and management of chylous ascites following pediatric liver transplantation. Liver Transpl, 2019, 25(9): 1387-1396.
33.	張全勝, 史源, 史瑞, 等. 肝移植后淋巴漏3例. 中國組織工程研究與臨床康復, 2010, 14(31): 5865-5868.
34.	戴敏, 朱海燕, 楊紅生, 等. 腹腔鏡胃癌根治術后胰瘺圍手術期預防策略. 中華腔鏡外科雜志(電子版), 2020, 13(4): 253-256.
35.	李世昊, 周君, 王曄, 等. 腹腔鏡結直腸癌術后乳糜漏的臨床診治. 腫瘤, 2023, 43(5): 389-393.
36.	Gruber-Rouh T, Naguib NNN, Lehnert T, et al. Direct lymphangiography as treatment option of lymphatic leakage: indications, outcomes and role in patient’s management. Eur J Radiol, 2014, 83(12): 2167-2171.
37.	曹暉, 趙恩昊. 胃手術后淋巴漏和乳糜漏原因及防治. 中國實用外科雜志, 2017, 37(4): 355-358.
38.	孫艷武, 池畔, 林惠銘, 等. 結腸癌完整結腸系膜切除術后乳糜漏的影響因素分析. 中華胃腸外科雜志, 2012, 15(4): 328-331.
39.	Park SH, Kim KY, Cho M, et al. Prognostic impact of fluorescent lymphography on gastric cancer. Int J Surg, 2023, 109(10): 2926-2933.
40.	張策, 高屹, 張旋, 等. 腹腔鏡左半結腸癌根治術后遲發性大量乳糜漏1例. 中國普通外科雜志, 2018, 27(12): 1624-1626.
41.	Tabchouri N, Frampas E, Marques F, et al. Chylous ascites management after pancreatic surgery. World J Surg, 2017, 41(4): 1054-1060.
42.	Matsuura T, Yanagi Y, Hayashida M, et al. The incidence of chylous ascites after liver transplantation and the proposal of a diagnostic and management protocol. J Pediatr Surg, 2018, 53(4): 671-675.

1. 李茁鈺, 劉凱, 張維漢, 等. 全球及中國胃癌的流行病學特點及趨勢: 2018–2022《全球癌癥統計報告》解讀. 中國普外基礎與臨床雜志, 2024, 31(10): 1236-1245.
2. Lin SZ, Tong HF, Ni ZL, et al. Treatment and prevention of lymphorrhea after radical gastrectomy of gastric cancer. J Cancer Res Clin Oncol, 2009, 135(4): 613-616.
3. 韋明光, 王楠, 吳濤, 等. 食管空腸overlap與π形吻合術后短期療效及患者生活質量的對比研究. 中國普通外科雜志, 2019, 28(4): 407-416.
4. 王秀茹. 乳糜性腹水247例國內文獻分析. 臨床薈萃, 2009, 24(6): 513-515.
5. Leibovitch I, Mor Y, Golomb J, et al. The diagnosis and management of postoperative chylous ascites. J Urol, 2002, 167(2 Pt 1): 449-457.
6. Bhardwaj R, Vaziri H, Gautam A, et al. Chylous ascites: a review of pathogenesis, diagnosis and treatment. J Clin Transl Hepatol, 2018, 6(1): 105-113.
7. 崔耀夫, 董永紅. 進展期胃癌腹主動脈旁淋巴結清掃對患者生存預后的影響. 中華腫瘤防治雜志, 2020, 27(S1): 94, 96.
8. Ilhan E, Demir U, Alemdar A, et al. Management of high-output chylous ascites after D2-lymphadenectomy in patients with gastric cancer: a multi-center study. J Gastrointest Oncol, 2016, 7(3): 420-425.
9. 鄧靖宇, 任寶清. 胃癌淋巴結清掃的臨床爭議和研究思緒. 中華胃腸外科雜志, 2022, 25(4): 361-366.
10. Laterre PF, Dugernier T, Reynaert MS. Chylous ascites: diagnosis, causes and treatment. Acta Gastroenterol Belg, 2000, 63(3): 260-263.
11. Degiuli M, De Manzoni G, Di Leo A, et al. Gastric cancer: current status of lymph node dissection. World J Gastroenterol, 2016, 22(10): 2875-2893.
12. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2025 (7th edition). Gastric Cancer, 2026, 29(2): 271-299.
13. Dong YP, Deng JY. Advances in para-aortic nodal dissection in gastric cancer surgery: a review of research progress over the last decade. World J Clin Cases, 2020, 8(13): 2703-2716.
14. 中國抗癌協會腹膜腫瘤專業委員會. 中國腫瘤整合診治指南: 腹膜腫瘤(胃腸腫瘤部分). 中華胃腸外科雜志, 2023, 26(2): 111-120.
15. Noji T, Narasaki H, Ebihara Y, et al. Near infrared fluorescence light imaging for lymphatic flow toward para-aortic lymph node from the Calot’s triangle: a prospective exploratory study. Photodiagnosis Photodyn Ther, 2018, 24: 274-279.
16. Griniatsos J, Dimitriou N, Kyriaki D, et al. Chylorrhea complicating D2+a gastrectomy: review of the literature and clarification of terminology apropos one case. Chin Med J (Engl), 2010, 123(16): 2279-2283.
17. 趙海遠, 劉剛, 李陽, 等. 體脂率作為預測胃癌手術后并發癥和生存率新指標的研究探討. 中國腫瘤臨床, 2023, 50(16): 821-828.
18. 陳豪, 余佩武, 黃昌明, 等. 腹腔鏡遠端胃癌D2根治術治療局部進展期胃癌10年預后及影響因素分析: 基于CLASS隊列的全國多中心研究. 中華消化外科雜志, 2022, 21(3): 362-374.
19. Duman MG, Alemdar A. Chylous leak management in gastric cancer patients after D2 dissection. Anatol J Gen Med Res, 2025, 35(2): 96-100.
20. Duletzke NT, Kiraly LN, Martindale RG. Chylothorax and chylous ascites: overview, management, and nutrition. Nutr Clin Pract, 2023, 38(3): 557-563.
21. 范巍, 段永利, 敷巖, 等. CT淋巴管造影成像的技術要點和成像參數. CT理論與應用研究, 2022, 31(4): 499-504.
22. 洪斯浩, 郝林, 李振亞, 等. 結內淋巴管造影在乳糜尿患者診治中的應用. 影像診斷與介入放射學, 2023, 32(6): 422-428.
23. Litchinko A, Monnard E, Tappero C, et al. Role of Lipiodol^? lymphangiography in the diagnosis and management of post-operative chylous ascites. Front Radiol, 2025, 5: 1537744. doi: 10.3389/fradi.2025.1537744.
24. Matsumoto T, Yamagami T, Kato T, et al. The effectiveness of lymphangiography as a treatment method for various chyle leakages. Br J Radiol, 2009, 82(976): 286-290.
25. Sommer CM, Pieper CC, Itkin M, et al. Conventional lymphangiography (CL) in the management of postoperative lymphatic leakage (PLL): a systematic review. Rofo, 2020, 192(11): 1025-1035.
26. Chavhan GB, Amaral JG, Temple M, et al. MR lymphangiography in children: technique and potential applications. Radiographics, 2017, 37(6): 1775-1790.
27. Pieper CC, Feisst A, Schild HH. Contrast-enhanced interstitial transpedal MR lymphangiography for thoracic chylous effusions. Radiology, 2020, 295(2): 458-466.
28. 黃秋雨, 王帥, 何悅, 等. 口腔頜面部惡性腫瘤頸淋巴清掃術后乳糜漏臨床營養管理專家共識. 中國口腔頜面外科雜志, 2025, 23(5): 425-433.
29. 楊孝清, 邱維誠, 陳中元. 下段食管癌切除術后經鼻和經皮穿刺放置空腸營養管的臨床轉歸. 實用臨床醫藥雜志, 2013, 17(1): 34-36, 40.
30. Ablan CJ, Littooy FN, Freeark RJ. Postoperative chylous ascites: diagnosis and treatment. A series report and literature review. Arch Surg, 1990, 125(2): 270-273.
31. Kong PF, Xu YH, Lai ZH, et al. Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery. World J Gastroenterol, 2022, 28(42): 6056-6067.
32. Miserachs M, Lurz E, Levman A, et al. Diagnosis, outcome, and management of chylous ascites following pediatric liver transplantation. Liver Transpl, 2019, 25(9): 1387-1396.
33. 張全勝, 史源, 史瑞, 等. 肝移植后淋巴漏3例. 中國組織工程研究與臨床康復, 2010, 14(31): 5865-5868.
34. 戴敏, 朱海燕, 楊紅生, 等. 腹腔鏡胃癌根治術后胰瘺圍手術期預防策略. 中華腔鏡外科雜志(電子版), 2020, 13(4): 253-256.
35. 李世昊, 周君, 王曄, 等. 腹腔鏡結直腸癌術后乳糜漏的臨床診治. 腫瘤, 2023, 43(5): 389-393.
36. Gruber-Rouh T, Naguib NNN, Lehnert T, et al. Direct lymphangiography as treatment option of lymphatic leakage: indications, outcomes and role in patient’s management. Eur J Radiol, 2014, 83(12): 2167-2171.
37. 曹暉, 趙恩昊. 胃手術后淋巴漏和乳糜漏原因及防治. 中國實用外科雜志, 2017, 37(4): 355-358.
38. 孫艷武, 池畔, 林惠銘, 等. 結腸癌完整結腸系膜切除術后乳糜漏的影響因素分析. 中華胃腸外科雜志, 2012, 15(4): 328-331.
39. Park SH, Kim KY, Cho M, et al. Prognostic impact of fluorescent lymphography on gastric cancer. Int J Surg, 2023, 109(10): 2926-2933.
40. 張策, 高屹, 張旋, 等. 腹腔鏡左半結腸癌根治術后遲發性大量乳糜漏1例. 中國普通外科雜志, 2018, 27(12): 1624-1626.
41. Tabchouri N, Frampas E, Marques F, et al. Chylous ascites management after pancreatic surgery. World J Surg, 2017, 41(4): 1054-1060.
42. Matsuura T, Yanagi Y, Hayashida M, et al. The incidence of chylous ascites after liver transplantation and the proposal of a diagnostic and management protocol. J Pediatr Surg, 2018, 53(4): 671-675.

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Advances in the diagnosis and management of chyle leak following gastric cancer surgery

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