Tondolo Vincenzo, Amodio Luca Emanuele, Marzi Federica, Livadoti Giada, Quero Giuseppe, Rizzo Gianluca
Digestive and Colo-Rectal Surgery Unit, Ospedale Isola Tiberina Gemelli Isola, 00186 Rome, Italy.
Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Cancers (Basel). 2025 Apr 23;17(9):1416. doi: 10.3390/cancers17091416.
The incidence of external lymphatic fistula (ELF) represents a relatively rare complication after surgery for colorectal cancer, especially in Western countries. However, the rate of this complication is progressively increasing following the introduction of complete mesocolic excision and central vascular ligation with consequent extensive lymphadenectomy. There are no guidelines for the management of ELF, with therapeutic options varying from conservative procedures to more invasive surgeries. The aim of this study was to retrospectively quantify the rate of ELF after surgery for colorectal cancer, to describe its management, and to evaluate its clinical impact on early postoperative outcomes in a tertiary referral European centre.
Data on all patients who underwent surgery for colorectal cancer at our institution between July 2022 and December 2024 were entered into a database. Preoperative, perioperative, and early (within 30 days) postoperative data were recorded.
A total of 279 patients underwent elective surgery for colorectal cancer (205 colon and 74 rectum). No postoperative deaths occurred within 30 days after surgery, and the rates of overall and major (grade ≥ 3) postoperative morbidity were 34.7% and 7.1%, respectively. The anastomotic leakage and reoperation rates were 2.8% and 5.3%, respectively. ELFs occurred in 15 patients (5.3%). In all patients, conservative treatment (based on fasting, total parenteral nutrition (TPN), and a prolonged medium-chain triglyceride (MCT) diet) was administered successfully. A recurrent ELF (after the first oral feeding resumption) occurred in four (26.6%) patients, but all were successfully treated with a conservative approach. The occurrence of an ELF prolonged the postoperative length of stay which was 12 days, a length higher than that recorded in patients without ELF.
The occurrence of an ELF was found to be a relatively frequent complication after surgery for colorectal cancer and appears to negatively influence only the postoperative length of stay. Conservative management appeared to be a successful treatment.
结直肠癌手术后发生外淋巴瘘（ELF）的情况相对少见，尤其是在西方国家。然而，随着完整结肠系膜切除术和中央血管结扎术的引入以及随之而来的广泛淋巴结清扫术，这种并发症的发生率在逐渐上升。目前尚无关于ELF管理的指南，治疗方案从保守治疗到更具侵入性的手术不等。本研究的目的是回顾性量化欧洲一家三级转诊中心结直肠癌手术后ELF的发生率，描述其管理方法，并评估其对术后早期结局的临床影响。
将2022年7月至2024年12月期间在我院接受结直肠癌手术的所有患者的数据录入数据库。记录术前、围手术期和术后早期（30天内）的数据。
共有279例患者接受了择期结直肠癌手术（205例结肠癌和74例直肠癌）。术后30天内无死亡病例，总体术后发病率和严重（≥3级）术后发病率分别为34.7%和7.1%。吻合口漏率和再次手术率分别为2.8%和5.3%。15例患者（5.3%）发生了ELF。所有患者均成功接受了保守治疗（基于禁食、全胃肠外营养（TPN）和延长的中链甘油三酯（MCT）饮食）。4例（26.6%）患者出现复发性ELF（首次恢复经口喂养后），但均通过保守方法成功治疗。ELF的发生延长了术后住院时间，为12天，这一长度高于未发生ELF患者的记录。
ELF的发生是结直肠癌手术后相对常见的并发症，似乎仅对术后住院时间有负面影响。保守治疗似乎是一种成功的治疗方法。
