Abstract No. 448 25 years’ experience with transpedal lymphangiography in the management of postoperative therapy-refractory lymphatic leakage: final results with subgroup analyses

Abstract

During the DCK (Deutscher ChirurgenKongress) 2019, the preliminary results of our 25-year experience on transpedal lymphangiography in the management of postoperative therapy-refractory lymphatic leakage were presented. In this update, the final results with subgroup analyses are summarized. The final cohort consisted of 355 patients who underwent transpedal lymphangiography with intention to cure postoperative therapy-refractory lymphatic leakage in different locations. Study goals included patient demographics and technical results as well as complication and cure rates. Dedicated subgroups analyses were performed to outline predictors for cure. Postoperative lymphatic leakage resulted from different in part highly complex surgical procedures in the neck, thorax, abdomen, pelvis and/or lower extremity. The daily drainage volume was 1124 ± 1336 mL. Technical success rate of, amount of injected iodized oil used for, and major and minor complication rates of transpedal lymphangiography were 87.2%, 10.3 ± 4.3 mL, and 0% and 0.3%, respectively. The cure rate of transpedal lymphangiography was 42.6%. Positive predictors for cure were radiologic extravasation/pooling of iodized oil under fluoroscopy, radiography and especially CT (yes vs. no; P = 0.006), type of lymphatic leakage (lymphatic fistula vs. lymphocele; P = 0.033), and the daily drainage volume (845 ± 1067 vs. 1316 ± 1399; P = 0.001). Transpedal lymphangiography is feasible, safe, and effective in the management of postoperative therapy-refractory lymphatic leakage. Under consideration of positive predictors for cure, different lymphatic second-line interventions should be scheduled prospectively, because according to our data lymphatic second-line interventions can increase dramatically the cure rate (e.g., CT-guided ethanol 95% sclerotherapy shows a cure rate of 76.9% after clinically ineffective transpedal lymphangiography).