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Nutritional management of chylous leakage following surgery for high-risk neuroblastoma in a toddler: a case report

European Journal of Clinical Nutrition volume 76, pages 626–628 (2022)Cite this article

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Neuroblastoma is the most common extracranial solid tumour in children and accounts for more than 7% of malignancies in patients younger than 15 years, with a median age of onset of 2 years. Neuroblastoma is a disease of the sympathoadrenal lineage of the neural crest and arises most often from the retroperitoneum. Almost half of patients with neuroblastoma present disease dissemination to distant lymph nodes, bone, and bone marrow already at the time of diagnosis. Treatment plan is designed according to disease risk stratification: any patient older than 12 months of age at diagnosis with metastatic disease and MYCN gene amplified, is considered as suffering from high-risk neuroblastoma (HR-NBL). HR-NBL treatment includes induction chemotherapy, surgery, consolidation with high-dose chemotherapy and autologous stem cell rescue, radiotherapy on the site of the primary tumour and a maintenance phase with 13-cis-retinoic acid and immunotherapy with an anti-disialoganglioside-2 monoclonal antibody [1].

Chylous leakage (CL) is a feared complication after surgery for abdominal neuroblastoma. Due to extensive retroperitoneal dissection (RPD), a disruption of lymphatic channels can occur leading to an extravasation of milky chyle rich in triglycerides into the peritoneal cavity. Fortunately, it can be treated conservatively through continuous drainage of CL associated with total parenteral nutrition (PN) or a peculiar oral diet, aiming to supply nutritional requirements and maintain trophic enteral feeding [2, 3].

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Fig. 1: Output leakage trend during the hospitalization.

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Authors and Affiliations

  1. Clinical Nutrition Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    Amanda Casirati, Giulia Mulazzani & Serena Della Valle

  2. Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    Roberto Luksch

  3. Department of Radiology, Interventional Radiology, Nuclear Medicine and Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    Carlo Morosi

  4. Urologic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    Davide Biasoni

Authors
  1. Amanda Casirati
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  2. Giulia Mulazzani
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  3. Roberto Luksch
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  4. Carlo Morosi
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  6. Serena Della Valle
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Contributions

Conceptualization: AC; Methodology: AC; Validation: AC, GM, RL, CM, DB, SDV; Formal analysis: AC, CM; Writing–original draft preparation: AC; Writing–review and editing: AC, GM, RL, CM, DB, SDV; Supervision: SDV. We thank Dr. Luca Pio for reviewing the manuscript.

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Correspondence to Amanda Casirati.

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Casirati, A., Mulazzani, G., Luksch, R. et al. Nutritional management of chylous leakage following surgery for high-risk neuroblastoma in a toddler: a case report. Eur J Clin Nutr 76, 626–628 (2022). https://doi.org/10.1038/s41430-021-00988-1

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