Expectant management of pediatric lymphatic malformations: A 30-year chart review

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.

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.

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.

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.