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Prognostic factors in the treatment of lymphatic malformations
E Raveh1, A L de Jong, G P Taylor
1Department of Otolaryngology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Aggressive, timely surgical excision improves outcomes for pediatric head and neck lymphatic malformations. Factors like single site and complete resection improve prognosis, while younger age and symptoms increase recurrence risk.
Area of Science:
- Pediatric Surgery
- Head and Neck Surgery
- Vascular Anomalies
Background:
- Lymphatic malformations (LMs) of the head and neck are congenital vascular anomalies.
- Treatment outcomes for pediatric LMs can vary significantly.
- Identifying prognostic factors is crucial for optimizing patient care.
Purpose of the Study:
- To determine factors influencing treatment outcomes in children with head and neck lymphatic malformations.
- To correlate various clinical and pathological parameters with surgical success.
Main Methods:
- Retrospective review of 85 children surgically treated for head and neck LMs (1988-1996).
- Analysis of outcomes based on age, symptoms, anatomical site, disease extent, time to surgery, resection completeness, and histology.
- Follow-up ranged from 6 months to 8 years.
Main Results:
- Overall recurrence rate was 22%; two neonates died.
- Favorable factors included single anatomical site, neck location, and complete resection.
- Younger age (especially neonates) and associated symptoms (infection, dyspnea, dysphagia, hemorrhage) correlated with higher recurrence.
Conclusions:
- Recommend aggressive, timely surgical excision for head and neck LMs.
- Surgical timing should balance functional/cosmetic deformity and likelihood of complete resection against morbidity.
- Early and complete surgical intervention is key for favorable outcomes.
Objective:
To find factors that may influence the treatment outcomes of lymphatic malformations of the head and neck in children.
Design:
Charts of patients treated surgically for lymphatic malformations of the head and neck between 1988 and 1996 at our tertiary care children's hospital were reviewed retrospectively. Outcomes were correlated with age at presentation, associated symptoms, anatomical site (s) of involvement, extent of disease, length of time between first symptoms and surgery, completeness of removal, and histologic pattern.
Patients:
Of 85 children treated, 74 underwent primary surgical excision at our hospital. Follow-up ranged from 6 months to 8 years, with a mean of 3 years.
Results:
The overall recurrence rate, judged by functional or cosmetic deformity, was 22%. Two neonates died of the disease. Factors associated with a better prognosis were a single anatomical site of involvement; location in the neck, even if involving 2 sites; and the impression of completeness of resection at the time of surgery. Findings associated with a higher recurrence rate included younger age (especially neonates) and the presence of associated symptoms (ie, infection, dyspnea, dysphagia, and hemorrhage). The histologic pattern and the length of time from diagnosis to treatment were not significantly associated with the prognosis.
Conclusions:
We recommend aggressive, timely surgical excision for lymphatic malformations of the head and neck. The timing of surgery should be based on the child's functional and cosmetic deformity at the time of presentation and on the likelihood of complete excision, weighed against the morbidity associated with surgical excision.