Treatment of symptomatic postoperative pelvic lymphoceles: A systematic review.

Autor: Ten Hove AS; Department of Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. Electronic address: a.s.tenhove@amsterdamumc.nl., Tjiong MY; Department of Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. Electronic address: m.tjiong@amsterdamumc.nl., Zijlstra IAJ; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. Electronic address: ij.a.zijlstra@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: European journal of radiology [Eur J Radiol] 2021 Jan; Vol. 134, pp. 109459. Date of Electronic Publication: 2020 Dec 02.
DOI: 10.1016/j.ejrad.2020.109459
Abstrakt: Purpose: A broad range of therapeutic options exists for symptomatic postoperative lymphoceles. However, no consensus exists on what is the optimal therapy. In this study, we aimed to compare the efficacy of currently available radiologic interventions in terms of number of successful interventions, number of recurrences, and number of complications.
Methods: A systematic review was conducted with a pre-defined search strategy for PubMed, EMBASE, and Cochrane databases from inception until September 2019. Quality assessment was performed using the 'Risk Of Bias In Non-randomized Studies - of Interventions' tool. Statistical heterogeneity was assessed using the I 2 and χ 2 test and a meta-analysis was considered for studies reporting on multiple interventions.
Results: 37 eligible studies including 732 lymphoceles were identified. Proportions of successful interventions for percutaneous fine needle aspiration, percutaneous catheter drainage, percutaneous catheter drainage with delayed or instantaneous addition of sclerotherapy, and embolization were as follows: 0.341 (95% confidence interval [CI]: 0.185-0.542), 0.612 (95% CI: 0.490-0.722), 0.890 (95% CI: 0.781-0.948), 0.872 (95% CI: 0.710-0.949), 0.922 (95% CI: 0.731-0.981). Random-effects meta-analysis of seven studies revealed a pooled relative risk for percutaneous catheter drainage with delayed addition of sclerotherapy of 1.57 (95% CI: 1.17-2.10) when compared to percutaneous catheter drainage alone. The risk of bias in this study was severe.
Conclusions: This systematic review demonstrates that the success rates of percutaneous catheter drainage with sclerotherapy are more favorable when compared to percutaneous catheter drainage alone in the treatment of postoperative pelvic lymphoceles. Overall, percutaneous catheter drainage with delayed addition of sclerotherapy, and embolization showed the best outcomes.
(Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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