Skip to main content
SpringerLink
Log in

Lymphatic Embolization versus Sclerotherapy for Symptomatic Post-operative Pelvic Lymphocele (LESPOL): A Randomized Pilot Study

  • Original Paper
  • Published:
SN Comprehensive Clinical Medicine Aims and scope Submit manuscript

Abstract

This study was performed to compare clinical outcomes of lymphatic n-butyl cyanoacrylate (NBCA) embolization and ethanol sclerotherapy in patients with symptomatic postoperative pelvic lymphoceles. This prospective, open-label, randomized, and controlled trial took place at two medical centers in Korea. Patients ≥ 18 years old with symptomatic postoperative pelvic lymphoceles were randomly assigned (1:1) to one of two study arms: embolization or sclerotherapy. A target of 44 patients was set for each group to assess clinical outcomes. The trial began in August 2018 but ended as a pilot study in February 2020. Problematic patient enrollment precluded full population recruitment, only 11 patients (embolization, 5; sclerotherapy, 6) eventually participating. Clinical success and drainage tube removal rates were 100% in both arms. To achieve clinical success, significantly more procedures were needed in the sclerotherapy group than in the embolization group (4.5 ± 1.23 vs 2.0 ± 1.00; p < 0.001). The time to achieve daily drainage reduction thresholds (< 20 mL or < 20% of initial daily drainage) was also less in the sclerotherapy (vs embolization) group but fell short of statistical significance (4.8 ± 2.63 days vs 7.0 ± 3.67 days; p = 0.267). No significant adverse events or recurring symptomatic lymphoceles were evident at 3-month follow-up visits. Both NBCA embolization and ethanol sclerotherapy might be safe and effective in treating symptomatic postoperative pelvic lymphoceles, showing no significant difference in clinical outcomes. In a future randomized prospective study, it is essential to establish better inclusion criteria to selectively include intractable lymphoceles to find out the difference in the outcome between the two treatments.

Trial registration: The study is registered as KCT0003078 at the Clinical Research Information Service (http://cris.nih.go.kr). Registered April 2, 2018.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code Availability

Not applicable.

Abbreviations

PCD :

Percutaneous catheter drainage

NBCA :

N-Butyl Cyanoacrylate

References

  1. Kim HY, Kim JW, Kim SH, Kim YT, Kim JH. An Analysis of the Risk Factors and Management of Lymphocele after Pelvic Lymphadenectomy in Patients with Gynecologic Malignancies. Cancer Res Treat. 2004;36(6):377. https://doi.org/10.4143/crt.2004.36.6.377.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Angelo N, Rossana A, Carlo I, Vincenzo F, Paolo P. Predictors of Symptomatic Lymphocele After Lymph Node Excision and Radical Prostatectomy. Urology. 2010;75(3):630–5. https://doi.org/10.1016/j.urology.2009.03.011.

    Article  Google Scholar 

  3. Keskin MS, Argun ÖB, Öbek C, Tufek I, Tuna MB, Mourmouris P, et al. The incidence and sequela of lymphocele formation after robot-assisted extended pelvic lymph node dissection. Bju Int. 2016;118(1):127–31. https://doi.org/10.1111/bju.13425.

    Article  PubMed  Google Scholar 

  4. Igor T, Christian T. Risk factors, complications and management of lymphocele formation after radical prostatectomy: A mini-review. Int J Urology Official J Jpn Urological Assoc. 2019;26(7):711–6. https://doi.org/10.1111/iju.13964.

    Article  Google Scholar 

  5. Kim JK, Jeong YY, Kim YH, Kim YC, Kang HK, Choi HS. Postoperative pelvic lymphocele: treatment with simple percutaneous catheter drainage. Radiology. 1999;212(2):390–4. https://doi.org/10.1148/radiology.212.2.r99au12390.

    Article  CAS  PubMed  Google Scholar 

  6. Akhan O, Karcaaltincaba M, Ozmen MN, Akinci D, Karcaaltincaba D, Ayhan A. Percutaneous transcatheter ethanol sclerotherapy and catheter drainage of postoperative pelvic lymphoceles. Cardiovasc Intervent Radiol. 2007;30(2):237–40. https://doi.org/10.1007/s00270-006-0180-y.

    Article  PubMed  Google Scholar 

  7. Mahrer A, Ramchandani P, Trerotola SO, Shlansky-Goldberg RD, Itkin M. Sclerotherapy in the management of postoperative lymphocele. J Vasc Interv Radiol. 2010;21(7):1050–3. https://doi.org/10.1016/j.jvir.2010.03.014.

    Article  PubMed  Google Scholar 

  8. Kos S, Haueisen H, Lachmund U, Roeren T. Lymphangiography: forgotten tool or rising star in the diagnosis and therapy of postoperative lymphatic vessel leakage. Cardiovasc Intervent Radiol. 2007;30(5):968–73. https://doi.org/10.1007/s00270-007-9026-5.

    Article  PubMed  Google Scholar 

  9. Nadolski GJ, Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol. 2012;23(5):613–6. https://doi.org/10.1016/j.jvir.2012.01.078.

    Article  PubMed  Google Scholar 

  10. Hur S, Shin JH, Lee IJ, Min SK, Min SI, Ahn S, et al. Early Experience in the Management of Postoperative Lymphatic Leakage Using Lipiodol Lymphangiography and Adjunctive Glue Embolization. J Vasc Interv Radiol. 2016;27(8):1177-86 e1. https://doi.org/10.1016/j.jvir.2016.05.011.

    Article  PubMed  Google Scholar 

  11. Baek Y, Won JH, Kong TW, Paek J, Chang SJ, Ryu HS, et al. Lymphatic Leak Occurring After Surgical Lymph Node Dissection: A Preliminary Study Assessing the Feasibility and Outcome of Lymphatic Embolization. Cardiovasc Intervent Radiol. 2016;39(12):1728–35. https://doi.org/10.1007/s00270-016-1435-x.

    Article  PubMed  Google Scholar 

  12. Chu HH, Shin JH, Kim JW, Noh SY, Yang WJ, Park S. Lymphangiography and Lymphatic Embolization for the Management of Pelvic Lymphocele After Radical Prostatectomy in Prostatic Cancer. Cardiovasc Intervent Radiol. 2019;42(6):873–9. https://doi.org/10.1007/s00270-019-02209-6.

    Article  PubMed  Google Scholar 

  13. Kim SW, Hur S, Kim SY, Cho JY, Kwak C, Kim HS, et al. The Efficacy of Lymph Node Embolization Using N-Butyl Cyanoacrylate Compared to Ethanol Sclerotherapy in the Management of Symptomatic Lymphorrhea after Pelvic Surgery. J Vasc Interv Radiol. 2019;30(2):195-202 e1. https://doi.org/10.1016/j.jvir.2018.09.038.

    Article  PubMed  Google Scholar 

  14. Frost JA, Webster KE, Bryant A, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2017;10:CD007585. https://doi.org/10.1002/14651858.CD007585.pub4.

    Article  PubMed  Google Scholar 

  15. Lin H, Ding Z, Kota VG, Zhang X, Zhou J. Sentinel lymph node mapping in endometrial cancer: a systematic review and meta-analysis. Oncotarget. 2017;8(28):46601–10. https://doi.org/10.18632/oncotarget.16662.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors are grateful for the statistical expertise provided by the Medical Research Collaborating Center at Seoul National University Hospital.

Funding

This study was funded by a grant from the Guerbet Korea Research Fund.

Author information

Authors and Affiliations

  1. Department of Radiology, Hospital / Division of Clinical Research, Research Institute, National Cancer Center, Goyang-Si, Gyeonggi-Do, Republic of Korea

    In Joon Lee

  2. Department of Radiology, Ajou University School of Medicine, Suwon, Gyeonggi-Do, Republic of Korea

    Jinoo Kim

  3. Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Gyoung Min Kim

  4. Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Ji Hoon Shin

  5. Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea

    Hee Seung Kim

  6. Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea

    Cheol Kwak

  7. Department of Urology, Center for Urologic Cancer, Hospital / Division of Tumor Immunology, Research Institute, National Cancer Center, Goyang-Si, Gyeonggi-Do, Republic of Korea

    Ho Kyung Seo

  8. Center for Gynecologic Cancer, Hospital / Division of Tumor Immunology, Research Institute, National Cancer Center, Goyang-Si, Gyeonggi-Do, Republic of Korea

    Myong Cheol Lim

  9. Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea

    Saebeom Hur

Authors
  1. In Joon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jinoo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gyoung Min Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ji Hoon Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hee Seung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cheol Kwak
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ho Kyung Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Myong Cheol Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Saebeom Hur
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

In Joon Lee: Project management, data collection and analysis, manuscript writing and editing.

Jinoo Kim: Project development and management, data analysis, manuscript editing.

Gyoung Min Kim: Project management, manuscript editing.

Ji Hoon Shin: Project management, manuscript editing.

Hee Seung Kim: Data collection, manuscript editing.

Cheol Kwak: Data collection, manuscript editing.

Ho Kyung Seo: Data collection, manuscript editing.

Myong Cheol Lim: Data collection, manuscript editing.

Saebeom Hur: Project development and management, data collection and analysis, manuscript writing and editing.

Corresponding author

Correspondence to Saebeom Hur.

Ethics declarations

Ethics Approval and Consent to Participate

The study protocol was approved by the Institutional Review Board of Seoul National University Hospital (No. 1802–100-924) and the National Cancer Center (No. NCC2018-0144). All patients granted written informed consent and all data were de-identified after collection.

Consent for Participate

Informed consent was obtained from all patients.

Consent for Publication

Not applicable.

Competing Interests

None of the authors has any conflicts to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Surgery

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, I.J., Kim, J., Kim, G.M. et al. Lymphatic Embolization versus Sclerotherapy for Symptomatic Post-operative Pelvic Lymphocele (LESPOL): A Randomized Pilot Study. SN Compr. Clin. Med. 5, 96 (2023). https://doi.org/10.1007/s42399-023-01432-0

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s42399-023-01432-0

Keywords

Search

Navigation