Treatment of Chylous Ascites with Peritoneovenous Shunt (Denver Shunt) following Retroperitoneal Lymph Node Dissection in Patients with Urologic Malignancies: Update of Efficacy and Predictors of Complications.

To investigate the efficacy and analyze the complication risk factors of peritoneovenous shunt (PVS) in treating refractory chylous ascites (CA) following retroperitoneal lymph node dissection (RPLND) in patients with urologic malignancies.From April 2001 to March 2019, all patients with refractory CA after RPLND treated with PVS were reviewed. Demographic characteristics, technical success, efficacy, patency period and complications were studied. Univariate and multivariate logistic regression analysis was performed to identify predictors of complications.

Twenty patients were included in this study. Testicular cancer was the most common malignancy (85%). The mean number of days from surgery to detection of CA was 21 days (SD 15, range 4-65 days). Ascites permanently resolved after PVS in 18 patients (90%), leading to shunt removal in 17 patients (85%) between 46 and 481 days (mean 162, SD 141days). The mean serum albumin level increased 24% after shunt placement (mean 3.0±0.6g/dl before, 3.9±0.8g/dl after; p < 0.05). The most common complication was occlusion (30%). Relative risk of complications increased significantly when shunt placement was more than 70 days after surgery and in patients receiving more than 5 paracenteses before PVS placement (AR 0.71% vs 0.25%, RR 2.9, p<0.048 and AR 0.6% vs 0.125%, RR 4.8, p<0.04, respectively).

PVS permanently treated CA in 90% of patients after RPLND. PVS was removed in 85% of patients. Shunt placement is an effective and safe treatment option for refractory CA. These patients might benefit from earlier intervention, after 4-6 week of conservative management as opposed to 2-3 months.