Sclerotherapy Safe for Post-op Lymphoceles

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Investigators find that the treatment was successful in 80% of patients.

 

WASHINGTON, D.C.—Sclerotherapy of postoperative lymphoceles is safe and effective, but the success of this approach may be directly related to the size of the lymphocele cavity, according to new data.

 

Lymphoceles commonly occur following surgical procedures such as prostatectomies, perineal resection for genitourinary malignancy, vascular bypass procedures, and renal transplantation. Researchers at the University of Pennsylvania in Philadelphia studied 41 patients (22 females, 19 males) with post-surgical lymphocele.

 

The patients had a mean age of 53 years. All were treated using betadine, alcohol, or doxycycline. Treatments were repeated at weekly intervals. The researchers retrospectively examined the initial drainage volume of the lymphocele, the location of the lymphocele, the number of the treatments and the outcomes.

 

“We summarized our experience with all the patients we treated from 1999 through 2007 and this is now probably the largest series described in the literature,” said study investigator Maxim Itkin, MD, assistant professor of radiology. “We found that the bigger the cavity, the lower the success rate.”

 

In this series of patients, 36 had their lymphocele drained percutaneously. In five patients the treatment was initiated through an existing surgically placed drainage tube. Of the 41 patients, 17 had a kidney transplant and three had undergone prostatectomy. Sclerotherapy was successful in 33 (80%) patients.

 

Five patients (12%) experienced complications that resulted in treatment discontinuation, Dr. Itkin said. These complications included testicular pain, cellulites, post-treatment elevated creatinine, acute renal tubular necrosis, and abdominal infection. In one patient, the lymphocele resolved after resolution of the infection. No difference was observed in the success rate between superficial intra-abdominal and soft tissue lymphoceles.

 

Dr. Itkin's group observed a statistically significant difference in the fluid volume at initial drainage between the failure group (1,625 mL) and the success group (206 mL).

 

The largest initial volume treated successfully with sclerotherapy was 1000 cc. For volumes greater than this, it may be best to consider other treatment approaches, he noted.

 

“The most important message that we can relay right now is that sclerotherapy may be a waste

of time on lymphoceles that are too large,” Dr. Itkin told Renal & Urology News.

 

“Sclerotherapy never works in one treatment. It is usually effective over a course of several weeks of treatment. So why would you want to waste time on a treatment that we know will probably be unsuccessful for the large-volume lymphoceles? The other alternatives are surgical treatments or percutaneous image-guided lymphatic duct ligation, currently under development at the University of Pennsylvania.”

 

Findings were reported here at the Society of Interventional Radiology annual meeting.

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