[A Case of Intractable Chylorrhea Following Breast Cancer Surgery with a History of Liver Cirrhosis]

We present a case of intractable chylorrhea following breast cancer surgery in a 75-year-old female. During a close examination for a mass in her left breast, which was indicated by a CT scan performed to test for nausea, cancer of the left breast and an enlarged left axillary lymph node were observed. The FNA of the axillary lymph node was unsuitable as a sample since no lymph node cell-derived components were observed. A left breast mastectomy and axillary lymph node dissection were performed for the evaluation of cT2N1M0, Stage ⅡB. On postoperative day 3, cloudy drainage was observed, leading to a diagnosis of chylorrhea. Despite management by a fat-restricted diet and peripheral infusion on postoperative day 4, chyle from the drainage remained high, with a TG of 257 mg/dL, a cell count of 525/mm3(70% lymphocytes), and a postoperative drainage volume of over 500 mL per day. On postoperative day 8, octreotide subcutaneous injection was started, and drainage could be reduced. Locally injected picibanil solution through the drain on postoperative days 12 and 17 further decreased the drainage to 20 mL/day, and the drain was removed. The patient was discharged on postoperative day 22. The occurrence of chylorrhea was a concern due to the risk of distal hepatic collateral flow, regional lymph nodes and vessels, and high hepatic flow pressure due to liver cirrhosis.