Abstract
To assess outcome and predictors of outcome after lymphatic embolization (LE) for early postoperative lymphatic leak after pelvic surgery. Lymphangiography (LG) performed between May 2015 and February 2020 for lymphatic leaks after pelvic surgery were reviewed. Treatment indication was lymphatic drainage > 500 mL/day persisting > 1 week. Lymphatic embolization (LE) was performed by injecting glue into the iliac lymph node. Fisher exact and Wilcoxon ranked sum tests were used for comparative analysis, and Logistic regression to assess predictors of outcome. LG was performed in 71 patients. Leak was demonstrated in 69 patients who underwent LE. Mean drainage was 1,329 mL/day (± 773 mL/day, SD). Catheters were removed in 49 patients (69.0%) after one procedure and in 69 (97.2%) after mean 1.3 procedures. Mean drainage at time of catheter removal was 157 mL/day (± 100 ml/day, SD). Failure occurred in 12 cases (16.9%), including 2 cases (2.8%) of unsuccessful catheter removal and 10 cases (14.1%) of catheter re-insertion due to recurrent ascites (N=3) and lymphoceles (N=7). Older age and drainage > 1,500 mL/day was associated with failure (P = .004). Drainage > 1,500 mL/day was associated with post-LE catheter dwell time longer than one week (P = .024). Minor complication was noted in four patients who presented with transient leg swelling (5.6%). LE is effective for treating pelvic surgery-related lymphatic leak. Re-intervention may be required. Drainage > 1,500 mL/day is associated with clinical failure and with post-LE catheter dwell time longer than one week.
Published Version
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