TITLE:
Successful Control of Intractable Lymphatic Ascites after Pelvic Lymphadenectomy for Cervical Cancer Using Cell-Free and Concentrated Ascites Reinfusion Therapy (CART): A Case Report
AUTHORS:
Kyousuke Takeuchi, Akari Shirakuni, Moe Kano, Ai Yoshida, Yui Yamasaki, Makoto Sugimoto, Kazuya Shimizu
KEYWORDS:
Cell-Free and Concentrated Ascites Reinfusion Therapy (CART), Lymphatic Ascites, Pelvic Lymphadenectomy
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.15 No.11,
November
5,
2025
ABSTRACT: Lymphatic leakage following systematic lymphadenectomy is an uncommon but potentially severe complication in gynecologic surgery. Intractable lymphatic ascites can persist for several months and be refractory to conservative therapies. Cell-free and concentrated ascites reinfusion therapy (CART) has been utilized primarily in patients with malignancy-associated ascites to improve symptoms and nutritional status. We report a case of intractable lymphatic ascites after pelvic lymphadenectomy for stage IB2 cervical squamous cell carcinoma that was successfully managed with CART. A 52-year-old woman underwent radical hysterectomy and pelvic lymphadenectomy. She developed progressive ascites without evidence of malignancy or chylous leakage. Despite conservative measures, including paracentesis (2000 mL on POD 42), albumin infusion, and a 4-day course of octreotide, ascites persisted. CART was performed on postoperative days 51 and 85, resulting in gradual resolution of ascites by day 118. This case highlights the potential utility of CART in managing refractory lymphatic ascites after gynecologic oncologic surgery.