Percutaneous Lymphatic Embolization as Primary Management of Pelvic and Retroperitoneal Iatrogenic Lymphoceles

doi:10.1016/j.jvir.2021.07.022

Journal of Vascular and Interventional Radiology

Volume 32, Issue 11, November 2021, Pages 1529-1535

https://doi.org/10.1016/j.jvir.2021.07.022 Get rights and content

Abstract

Purpose

To evaluate the efficacy of lymphatic embolization (LE) in decreasing catheter output and dwell time in iatrogenic lymphoceles after percutaneous catheter drainage.

Materials and Methods

Retrospective review of patients who underwent intranodal lymphangiography (INL) with or without LE for management of iatrogenic lymphoceles between January 2017 and November 2020 was performed. Twenty consecutive patients (16 men and 4 women; median age, 60.5 years) underwent a total of 22 INLs and 18 LEs for 15 pelvic and 5 retroperitoneal lymphoceles. Lymphatic leaks were identified in 19/22 (86.4%) of the INLs. Three patients underwent INL only because a leak was not identified or was identified into an asymptomatic lymphocele. One patient underwent repeat INL and LE after persistent high catheter output, and 1 patient underwent repeat INL with LE after the initial INL did not identify a leak. Catheter output was assessed until catheter removal, and changes in output before and after the procedure were reported. The patients were followed up for 2–30 months, and procedural complications were reported.

Results

The median catheter output before the procedure was 210 mL/day (50–1,200 mL/day), which decreased to a median of 20 mL/day (0–520 mL/day) 3 days after the procedure, with a median output decrease of 160 mL (0–900 mL). The median time between INL with LE and catheter removal was 6 days, with no recurrence requiring redrainage. Four patients experienced minor complications of low-grade fever (n = 2) and lower limb edema (n = 2).

Conclusions

Lymphangiogram and LE are safe and effective methods for the management of lymphoceles.

Section snippets

Patient Population and Lymphocele Characteristics

This retrospective study was approved by the institutional review board of Memorial Sloan Kettering Cancer Center (approval number: 16-402). Review of medical records identified 20 consecutive patients (16 men and 4 women) with a median age of 60.5 years (39–73 years) who underwent a total of 22 intranodal lymphangiography (INL) procedures and 18 LE procedures for the management of 15 pelvic and 5 retroperitoneal iatrogenic lymphoceles following percutaneous drainage catheter placement from

Lymphangiogram Findings and Initial Management

The median time between the original surgery and lymphatic intervention was 36 days (14–180 days). The median time between percutaneous drainage and lymphatic intervention was 9.5 days (0–38 days). Three patients underwent same-session percutaneous drainage and lymphatic intervention after a discussion with the referring urologist. The median catheter output before the procedure was 210 mL/day (50–1,200 mL/day). Two patients underwent only INL because a leak was not identified. One patient

Discussion

LND is an important part of surgical treatment for several malignancies (15,16). With its proven superiority in staging compared with imaging, along with a potential survival benefit incurred with an extended LND compared with the standard LND, LND is an integral part of surgical oncology (15,17). Since an increasing number of patients are undergoing LND and since the extent of LND is expected to increase, more patients are expected to experience symptomatic lymphoceles (18,19).

Sclerotherapy is

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Cited by (11)

Therapeutic lymphangiography with ethiodized oil for the management of lymphoceles and chylous ascites
2023, Diagnostic and Interventional Imaging
The purpose of this study was to analyze the safety, technical success and clinical outcome of percutaneous intranodal ethiodized oil (Lipiodol®) based lymphangiography (L-LAG) for the management of refractory pelvic lymphoceles or chylous ascites using high doses of ethiodized oil.
Thirty-four patients presenting with symptomatic, refractory postoperative pelvic lymphocele or chylous ascites referred for theranostic, inguinal, intranodal L-LAG treatment between May 2018 and November 2021 were retrospectively included. There were 21 men and 13 women, with a mean age of 62.7 ± 16.2 (standard deviation) years (age range: 9–86 years), who underwent a total of 49 L-LAG for the management of lymphoceles (n = 14), chylous ascites (n = 18) or a combination of lymphocele and chylous ascites (n = 2). Clinical and radiological pre-interventional, procedural and follow-up data up to January 2022 were collected from patients’ electronic medical records and imaging files.
Technical success was obtained in 48 out of 49 L-LAG (98%). No complications related to L-LAG were noted. After one or more L-LAG, clinical success was obtained in 30 patients (88%) with a mean of 1.4 interventions per patient and mean intranodal injected volume of 29 mL of ethiodized oil per session. The remaining four patients (12%), with one or more failed L-LAG, underwent additional surgical intervention to definitively treat the postoperative lymphatic leakage.
L-LAG using high doses of ethiodized oil is a minimally invasive, safe and effective treatment of postoperative pelvic lymphocele or chylous ascites. Multiple sessions may be needed to obtain a meaningful clinical result.
Intranodal Glue Embolization for Postoperative Lymphatic Leaks in the Groin and Pelvis: Comparison with Sclerotherapy
2023, Journal of Vascular and Interventional Radiology
To compare the effectiveness of and adverse events related to intranodal glue embolization (IGE) with those of intracavitary sclerotherapy for the treatment of postoperative groin and pelvic lymphatic leaks.
From November 2015 to July 2021, IGE for postoperative pelvic or groin lymphocele or lymphorrhea was performed in 33 patients. From January 2010 to July 2021, 28 patients with postoperative pelvic or groin lymphocele were treated with sclerosis alone. Clinical success was defined as resolution of drainage within 3 weeks of the last intervention performed without recurrence. Patients presenting >1 year after surgery or with <30 days of follow-up were excluded. Patients with lymphorrhea treated with IGE were not statistically compared with those in the sclerosis group because they were not eligible for sclerosis.
Clinical success was similar between the groups (lymphocele IGE, 15/18, 83.3%, vs sclerosis, 15/23, 65.2% [P = .29]; lymphorrhea IGE, 8/9, 88.9%). The mean number of interventions performed to successfully treat a lymphocele was significantly higher in the sclerosis group (2.5 for sclerosis vs 1.3 for IGE; P = .003; lymphorrhea IGE, 1.0). The mean time to resolution was significantly longer for sclerosis than for IGE (27 vs 7 days; P = .002; 4 days for lymphorrhea IGE). There were no sclerosis-related adverse events and 2 IGE-related adverse events: (a) 1 case of mild lymphedema and (b) 1 case of nontarget embolization resulting in deep vein thrombosis.
For treatment of postoperative pelvic and groin lymphoceles, IGE results in faster resolution with fewer interventions compared with sclerosis. IGE is also an effective treatment for postoperative groin lymphorrhea.
The Sonographic Detection of an Obstructive Pelvic Lymphocele
2024, Journal of Diagnostic Medical Sonography
Back to the Future II - A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions
2023, Investigative Radiology
A comparison of lymphatic embolization and sclerotherapy in the management of iatrogenic abdominopelvic lymphoceles following oncological surgery
2023, Diagnostic and Interventional Radiology
Imaging and Interventions for Lymphatic and Lymphatic-related Disorders
2023, Radiology

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: None of the authors have identified a conflict of interest.

: This research was funded in part by the NIH/NCI Cancer Center Support Grant P30 CA008748.

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Clinical StudyPercutaneous Lymphatic Embolization as Primary Management of Pelvic and Retroperitoneal Iatrogenic Lymphoceles

Abstract

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Patient Population and Lymphocele Characteristics

Lymphangiogram Findings and Initial Management

Discussion

Eur J Radiol

Urology

J Vasc Interv Radiol

Taiwan J Obstet Gynecol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

Eur Urol

J Vasc Interv Radiol

Polidocanol foam sclerotherapy is a new and effective treatment for post-operative lymphorrhea and lymphocele

J Eur Acad Dermatol Venereol

The incidence and sequela of lymphocele formation after robot-assisted extended pelvic lymph node dissection

BJU Int

Risk factors, complications and management of lymphocele formation after radical prostatectomy: a mini-review

Int J Urol

Postoperative pelvic lymphocele: treatment with simple percutaneous catheter drainage

Radiology

Clinical Study
Percutaneous Lymphatic Embolization as Primary Management of Pelvic and Retroperitoneal Iatrogenic Lymphoceles