2022 Volume 47 Issue 6 Pages 727-733
[Background] Postoperative lymphorrhea is often a serious condition because it causes massive body fluid loss. The condition can be controlled by fasting or fat restriction in most cases, however, some cases do not respond to conservative therapy. There are no established treatment methods for such cases, and surgery is often considered.
[Case] 65-year-old man. After 5 courses of SOX + trastuzumab therapy, he underwent laparoscopic total gastrectomy, R-Y reconstruction, D2 + para Ao lymph node dissection as conversion surgery. On the 2nd postoperative day, the amount of drainage was about 930 ml/day. As he started eating on the 6th postoperative day, the drainage increased to a maximum of 3,800 ml/day. Because there was no evidence of chyliferous leakage, we assumed hepatic lymph leakage. The drainage amount remained at about 800 ml/day even after abstention of oral intake by the patient. Therefore, we considered it as a case of refractory lymphorrhea, and treated the patient by continuous subcutaneous injection of 300 μg/day of octreotide. The drainage decreased in response to this treatment, and the octreotide administration was discontinued on the 7th day. The patient started eating on the 20th postoperative day. After confirming that there was no increase in drainage, the drain was removed on the 22nd postoperative day.
We encountered a case of refractory lymphorrhea after chemotherapy for gastric cancer, in which octreotide proved effective.
