Treatment of Postoperative Lymphatic Leakage Applying Transpedal Lymphangiography – Experience in 355 Consecutive Patients

Abstract

Purpose Report of experience from a single institution in treating postoperative lymphatic leakage (PLL) applying conventional transpedal lymphangiography (TL).

Materials and Methods 453 patients with the initial diagnosis of PLL receiving TL between 03/1993 and 09/2018 were identified in the database. Only patients with confirmed PLL were included in the study. The technical success, safety, and treatment success of TL were evaluated. Independent predictors of TL treatment failure were examined using univariate and multivariate logistic regression analysis.

Results 355 consecutive patients (218 men, 137 women; median age of 62 years) who underwent TL for PLL (e. g., chylothorax) after ineffective conservative treatment were included. The median time between causal surgery and TL was 27 days. The median technical success rate of TL was 88.5 %, with a median volume of Lipiodol of 10.0 ml. No complication of TL was recorded. Three groups were defined according to the different clinical courses: group A (41/355, 11.5 %) – TL with technical failure; group B (258/355, 72.7 %) – “therapeutic” TL alone with technical success; and group C (56/355, 15.8 %) – “diagnostic” TL with simultaneously invasive treatment (incl. surgical revision and percutaneous sclerotherapy). Treatment success rate and median time to treatment success were higher in group C than in group B, but without significant differences (64.3 % vs. 61.6 %, p = 0.710; six vs. five days, p = 0.065). Univariate and multivariate logistic regression analyses for group B confirmed drainage volume (> 500 ml/d) and Lipiodol extravasation as independent predictors of TL clinical failure (odds ratios [ORs] of 2.128 and 2.372 [p = 0.005 and p = 0.003, respectively]).

Conclusion TL is technically reliable, safe, and effective in treating PLL. When conservative treatment fails, TL can be regarded as the next treatment option.

Key Points: 

• TL is technically reliable, safe, and effective for treating PLL.

• When conservative treatment fails, TL can be regarded as the next treatment option.

• Drainage volume > 500 ml/day is an independent predictor of clinical failure after TL.

• Lipiodol extravasation is an independent predictor of clinical failure after TL.

Citation Format

• Pan F, Richter GM, Do TD et al. Treatment of Postoperative Lymphatic Leakage Applying Transpedal Lymphangiography – Experience in 355 Consecutive Patients. Fortschr Röntgenstr 2022; 194: 634 – 643

Zusammenfassung

Ziel Erfahrungsbericht über die interventionelle Behandlung der postoperativen Lymphleckage (PLL) mittels konventioneller transpedaler Lymphangiografie (TL).

Material und Methoden Über digitale Datenbanken konnten 453 Patienten identifiziert werden, die in unserer Klinik zwischen 03/1993 und 09/2018 eine TL erhielten. Von diesen Patienten wurden lediglich diejenigen eingeschlossen, die eine TL aufgrund einer PLL erhielten. Der technische Erfolg, die Sicherheit und das klinische Ergebnis der TL wurden bewertet. Unabhängige Prädiktoren für das klinische Versagen nach TL wurden mittels univariater und multivariater logistischer Regressionsanalyse identifiziert.

Results Bei 355 konsekutiven Patienten (218 Männer, 137 Frauen; medianes Alter 62 Jahre) wurde eine TL bei klinischem Versagen nach konservativer Behandlung einer PLL (z. B. Chylothorax) durchgeführt. Das mediane Zeitintervall zwischen kausaler Operation und TL betrug 27 Tage. Die mediane technische Erfolgsrate von TL betrug 88,5 % bei einem medianen Lipiodol-Volumen von 10,0 ml. Es wurde keine Komplikation der TL beobachtet. Entsprechend den verschiedenen klinischen Verläufen wurden 3 Patientengruppen definiert: Gruppe A (41/355, 11,5 %) – TL mit technischem Versagen; Gruppe B (258/355, 72,7 %) – „therapeutische“ TL allein mit technischem Erfolg; und Gruppe C (56/355, 15,8 %) – „diagnostische“ TL mit gleichzeitig invasiver Behandlung (inkl. chirurgische Revision und perkutane Sklerotherapie). Die mediane klinische Erfolgsrate und das mediane Zeitintervall bis zum klinischen Erfolg nach TL waren in Gruppe C höher als in Gruppe B, jedoch ergaben sich hierbei keine signifikanten Unterschiede (64,3 % vs. 61,6 %, p = 0,710; 6 vs. 5 Tage, p = 0,065). Univariate und multivariate logistische Regressionsanalysen für Gruppe B identifizierten das Drainagevolumen (> 500 ml/Tag) und die Extravasation von Lipiodol als unabhängige Prädiktoren für das klinische Versagen nach TL (Odds Ratios [ORs] von 2,128 und 2,372 [p = 0,005 bzw. p = 0,003]).

Schlussfolgerung Die TL ist technisch zuverlässig, sicher und wirksam bei der Behandlung der PLL. Wenn die konservative Behandlung versagt, kann die TL als nächste Behandlungsoption angesehen werden.

Kernaussagen: 

• Die TL ist technisch zuverlässig, sicher und wirksam bei der Behandlung der PLL.

• Wenn die konservative Behandlung versagt, kann die TL als nächste Behandlungsoption angesehen werden.

• Ein Drainagevolumen von > 500 ml/Tag ist ein unabhängiger Prädiktor für klinisches Versagen nach TL.

• Die Extravasation von Lipiodol ist ein unabhängiger Prädiktor für das klinische Versagen nach TL.

Key words

lymphography - lymphatic - fistula - postoperative complications - treatment effects

Publikationsverlauf

Eingereicht: 31. Mai 2021

Angenommen: 18. November 2021

Artikel online veröffentlicht:
26. Januar 2022

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