背景:确定根治性肾切除术和血栓切除术后乳糜漏(CL)的发生率和危险因素,并确定乳糜漏对肿瘤预后的影响。
方法:纳入2014年1月至2023年1月接受根治性肾切除术和血栓切除术的445例患者。CL定义为口服摄入或肠内营养后甘油三酯水平大于110mg/dL的乳糜的引流。采用多因素logistic回归分析确定术后(CL)的危险因素。Kaplan-Meier曲线用于比较总生存期和癌症特异性生存期。
结果:44例(9.9%)被诊断为(CL)。所有患者在术后6天内出现CL,中位时间为3天。在多变量逻辑回归分析中,Mayo分级和side是独立的患者相关危险因素。此外,操作方法,操作时间,淋巴结清扫数是独立的手术相关危险因素.在CL组和非CL组之间,总生存期和癌症特异性生存期均无统计学差异.
结论:基于本中心肾癌和癌栓患者的回顾性研究,我们发现危险因素是梅奥等级,侧面,操作方法,操作时间,和收集的淋巴结数量,CL的发生显著延长了住院时间,但对长期肿瘤结局无影响.
BACKGROUND: To define the incidence and risk factors of chyle leak (CL) after radical nephrectomy and thrombectomy and to determine the impact of chyle leak on oncological outcomes.
METHODS: A total of 445 patients who underwent radical nephrectomy and thrombectomy between January 2014 and January 2023 were included. CL is defined as the drainage of chyle with a triglyceride level greater than 110 mg/dL after oral intake or enteral nutrition. Multivariate logistic regression analysis was performed to identify the risk factors of postoperative (CL). The Kaplan-Meier curves were used to compare overall survival and cancer-specific survival.
RESULTS: 44 patients (9.9%) were diagnosed as (CL). All patients developed CL within 6 days after the operation with a median time of 3 days. In multivariate logistic regression analysis, Mayo grade and side were independent patient-related risk factors. In addition, operation approach, operation time, and number of lymph nodes harvested were independent surgery-related risk factors. Between the CL group and the non-CL group, neither overall survival nor cancer-specific survival showed statistical differences.
CONCLUSIONS: Based on this retrospective study of renal cell carcinoma and tumor thrombus patients in our center, we found that the risk factors were Mayo grade, side, operation approach, operation time, and number of lymph nodes harvested, and the occurrence of CL significantly prolonged hospital stay, but had no effect on long-term oncological outcomes.