Zielsetzung 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.
Material und Methoden 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.
Ergebnisse 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±1336ml. 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±4.3ml, and 0% and 0.3%, respectively. The cure rate of transpedal
lymphangiography was 42.6%. Positive predictors for cure were radiological extravasation
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).
Schlußfolgerungen 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).
