Background: Lymphatic malformations (LM) are rare congenital lesions with varied clinical presentations, from asymptomatic to life-threatening. Regardless of initial presentation, many are treated aggressively either surgically or medically. There is a scarcity of literature regarding expectant management, this study compares current literature surrounding the outcomes of LMs managed conservatively to a provincial database in which conservative management was the primary treatment.
Methods: Retrospective chart review of all pediatric patients diagnosed with a lymphatic malformation in Newfoundland and Labrador between 1989-2019. In total, 43 patients were reviewed, 2 were excluded due to inadequate follow up, 1 was excluded due to initial life-threatening presentation requiring intervention. Of these patients, 32 were managed conservatively without any intervention, 7 surgically, and 1 aspirated. Data extracted included age at referral, management, complications, clinical regression and patient satisfaction, years of follow up, and recurrence rate.
Results: Patients managed expectantly had partial or complete clinical regression in 81%. Anecdotal regression as reported by patients and family was 84%. This is compared to a 45% clinical regression with expectant management in the literature and a recent systematic review with a 48% overall regression rate with sclerotherapy [10,12]. Average follow up was 6 years and average time to regression was 6.6 years. No major complications were reported. Recurrence rate in expectant management was 0% versus 21% in surgical group.
Conclusions: Expectant management is a safe and viable alternative to more aggressive treatments and ultimately leads to regression in the majority of cases. It should be considered as first line for non-life-threatening lymphatic malformations.
Keywords: Lymphatic malformations; Pediatric Surgery.
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