Management and Outcomes of Pediatric Lymphatic Malformations: A Systematic Review From the APSA Outcomes and Evidence-Based Practice Committee
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Carlos Theodore Huerta, Alana L. Beres, Brian R. Englum, Katherine Gonzalez, Tamar Levene, Derek Wakeman, Yasmine Yousef, Brian C. Gulack, Henry L. Chang, Emily R. Christison-Lagay, Phillip Benson Ham, III, Sara A. Mansfield, Afif N. Kulaylat, Donald J. Lucas, Rebecca M. Rentea, Christopher P. Pennell, Jason P. Sulkowski, Katie W. Russell, Robert L. Ricca, Lorraine I. Kelley-Quon, Jun Tashiro, Kristy L. Rialon on behalf of the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee
Methods: Three questions regarding LM management were generated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Publicly available databases were queried to identify articles published from January 1, 1990, to December 31, 2021. A consensus statement of recommendations was generated in response to each question.
Results: The initial search identified 9326 abstracts, each reviewed by two authors. A total of 600 abstracts met selection criteria for full manuscript review with 202 subsequently utilized for extraction of data. Medical therapy, such as sirolimus, can be used as an adjunct with percutaneous treatments or surgery, or for extensive LM. Sclerotherapy can achieve partial or complete response in over 90% of patients and is most effective for macrocystic lesions. Depending on the size, extent, and location of the malformation, surgery can be considered.
Conclusion: Evidence supporting best practices for the safety and effectiveness of management for LMs is currently of moderate quality. Many patients benefit from multi-modal treatment determined by the extent and type of LM. A multidisciplinary approach is recommended to determine the optimal individualized treatment for each patient.
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What's the best way to treat lymphatic malformations? When is it indicated and how effective is the treatment? I'm Lizzie Lee from Cincinnati Children's Hospital, and this is an article you should know about. Texas Children's Hospital researchers did a systematic review focusing on 200 articles published from 1990 to 2021. They found that sclerotherapy had a success rate of over 90% for macrocystic lesions. Medications like errolimus are helpful for extensive malformations that are refractory to surgery and or sclerotherapy. Cerrolimus is also used as an initial treatment for extensive lymphatic malformations, for example, those that compromise the airway. Small asymptomatic lesions can be observed, while large symptomatic lesions need to be further divided into macrocystic, microcystic, or mixed lesions. If it is a localized lesion, surgery or sclerotherapy is effective. Let us know what you think in the comments below and stay tuned for more articles that you should know about.