Clinical analysis of surgical treatment for head and neck lymphatic malformations in children: a series of 128 cases

Abstract

Background: Lymphatic malformations (LMs) are caused due to abnormal lymphatic development, and mainly occur in neonates or young children. At present, the role of surgery in the treatment of head and neck LMs is still controversial, focusing mainly on surgical efficacy and indications.

Objective: This study aimed to explore the effect and influential factors of surgical treatment in children with head and neck LMs, hoping to provide a basis for rational selection of surgical indications.

Methods: This retrospective study enrolled 128 children with head and neck LMs and underwent surgical treatment in Beijing Children’s Hospital from May 2007 to June 2016. They were classified into three morphological groups: macrocystic, microcystic, and mixed. Based on de Serres staging, they were divided into five groups: stage I to V. The local lesion control rate, complication rate, and recurrence rate were summarized and analyzed.

Results: The rate of completely controlled and almost completely controlled in cases with head and neck LMs was 71.1%. The postoperative complication rate was 13.3%, and the postoperative recurrence rate was 11.9%. Statistically significant difference was found for local lesion control and postoperative recurrence rates between different morphological and clinical staging groups. Furthermore, the complication rate showed a significant difference between different morphological groups, but not between clinical staging groups.

Conclusions: Surgical resection in children with macrocystic, low-stage, or neck-limited LMs demonstrated better therapeutic effect, with fewer complications. However, the effect remained poor and had more complications for microcystic, diffused and high-stage patients. High stage and incomplete resection are considered as the main factors for postoperative recurrence. Current staging system for LMs has important predictive value in the prognosis of head and neck LMs. For LMs in posterior pharyngeal space, plasma ablation has certain advantages.

Chinese abstract

背景：淋巴畸形（LMs）是由淋巴发育异常引起的, 主要发生于新生儿或幼儿。目前, 外科手术在治疗头颈部LMs方面的作用仍存在争议, 特别是手术疗效和适应证方面。

目的：探讨头颈部LMs患儿手术治疗的效果及影响因素, 为合理选择手术适应症提供依据。

方法：回顾性研究了128例头颈部LMs患儿。他们于2007年5月至2016年6月在北京儿童医院接受手术治疗。他们被分为三个形态组：大囊性、微囊性和混合性。根据病情分期, 他们又被分五个组：I至V期。总结并分析了局部病变控制率、并发症发生率和复发率。

结果：头颈部LMS患者完全控制和几乎完全控制率为71.1%；术后并发症发生率13.3%；术后复发率11.9%。不同形态和临床分期组之间的局部病变控制和术后复发率有显著性差异。此外, 不同形态组之间的并发症发生率有显著差异, 而临床分期组之间的并发症发生率无显著差异。

结论：大囊性、早期或颈部局限性LMs患儿手术切除效果较好, 并发症少。然而, 对于微囊、弥漫性和晚期患者的疗效仍然较差, 并发症较多。晚期和不完全切除是术后复发的主要因素。目前的LMS分期系统对头颈部LMs的预后具有重要的预测价值。对于咽后空隙的LMs, 等离子消融具有一定的优势。

Keywords:

• Clinical analysis
• surgical treatment
• Children
• head and neck lymphatic malformations

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by Beijing Municipal Administration of Hospitals Clinical Technology Innovation Project grant (XMLX201701). Natural Science Foundation of Beijing Municipality (7182050). Beijing Municipal Administration of Hospitals’ Youth Program (QML20181202).