Intra‐abdominal chylovenous bypass treats retroperitoneal lymphangiomatosis

• Published in: Journal of surgical oncology 2020-01, Vol.121 (1), p.75-84
• Main Authors: Chen, Courtney, Chu, Sung‐Yu, Lin, Chieh, Liu, Ken‐Hao, Cheng, Ming‐Huei
• Format: Article
• Language: English
• Subjects: Abdomen; Adolescent; Adult; chylovenous bypass; extremity lymphedema; Female; Humans; Leg - diagnostic imaging; Leg - surgery; Lymph Nodes - transplantation; Lymphangioma - diagnostic imaging; Lymphangioma - surgery; Lymphedema; Magnetic Resonance Imaging; Middle Aged; NMR; Nuclear magnetic resonance; Quality of life; retroperitoneal lymphangiomatosis; Retroperitoneal Neoplasms - diagnostic imaging; Retroperitoneal Neoplasms - surgery; Retrospective Studies; Tomography, Emission-Computed, Single-Photon; vascularized lymph node transfer; Young Adult
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.25514

Background Retroperitoneal lymphangiomatosis (RL) is a rare form of primary lymphedema featuring aberrant retroperitoneal lymphatic proliferation. It causes recurrent cellulitis, repeated interventions, and poor life quality. This study aimed to investigate proper diagnositc criteria and surgical outcomes for RL with extremity lymphedema. Methods Between 2012 and 2018, 44 primary lower‐extremity lymphedema cases received lymphoscintigraphy, magnetic resonance imaging, and single‐photon electron computed tomography to detect RL. RL patients underwent vascularized lymph node transfers (VLNT) for extremity lymphedema and intra‐abdominal side‐to‐end chylovenous bypasses (CVB) for chylous ascites. Complications, CVB patency, and quality of life were evaluated postoperatively. Results Six RL patients (mean age of 30.3 years) had chylous ascites with five had lower‐extremity lymphedema. All CVBs remained patent, though one required re‐anastomosis, giving a 100% patency rate. Four unilateral and one bilateral extremity lymphedema underwent six VLNTs with 100% flap survival. Patients reported improved quality of life (P = 0.023), decreased cellulitis incidence (P = 0.041), and improved mean lymphedema circumference (P = 0.043). All patients resumed a normal diet and activity. Conclusions Evaluating primary lower‐extremity lymphedema patients with MRI and SPECT could reveal a 13.6% prevalence of RL and guide treatment of refractory extremity lymphedema. Intra‐abdominal CVB with VLNT effectively treated RL with chylous ascites and extremity lymphedema.