Background: 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. Methods: 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. Results: 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. Conclusions: 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.
背景：结直肠癌术后发生外淋巴瘘（ELF）是一种相对罕见的并发症，尤其在西方国家。然而，随着全结肠系膜切除联合中央血管结扎及广泛淋巴结清扫术的推广应用，该并发症的发生率正逐渐上升。目前尚无针对外淋巴瘘管理的指南，治疗方案从保守治疗到侵入性手术各不相同。本研究旨在回顾性分析欧洲一家三级转诊中心结直肠癌术后外淋巴瘘的发生率，描述其处理方法，并评估其对术后早期结局的临床影响。 方法：将2022年7月至2024年12月期间在本机构接受结直肠癌手术的所有患者数据录入数据库。记录术前、围手术期及术后早期（30天内）数据。 结果：共有279例患者接受了结直肠癌择期手术（结肠癌205例，直肠癌74例）。术后30天内无死亡病例，总体术后并发症发生率为34.7%，严重并发症（≥3级）发生率为7.1%。吻合口漏发生率为2.8%，再手术率为5.3%。15例患者（5.3%）发生外淋巴瘘。所有患者均成功接受保守治疗（包括禁食、全肠外营养及长期中链甘油三酯饮食）。4例患者（26.6%）在恢复首次经口进食后出现外淋巴瘘复发，但均通过保守治疗成功治愈。外淋巴瘘的发生使术后住院时间延长至12天，较未发生外淋巴瘘的患者住院时间更长。 结论：外淋巴瘘是结直肠癌术后相对常见的并发症，且似乎仅对术后住院时间产生负面影响。保守治疗显示出良好的治疗效果。
External Lymphatic Fistula After Radical Surgery for Colorectal Cancer: A Case Series
肿瘤(癌症)患者之家