Management and Outcomes of Pediatric Lymphatic Malformations (LM) | Systematic Review | APSA Outcomes & Evidence-Based Practice Committee | 1990-2021 | 600 abstracts met selection criteria for full manuscript review | 202 manuscripts subsequently utilized for extraction of data | Medical therapy (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: Many patients benefit from multi-modal treatment based on LM extent and type. A multidisciplinary approach is recommended to optimize individualized treatment. | https://pubmed.ncbi.nlm.nih.gov/38914511/ | Source: Huerta CT et. al. | DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA | @EmGooteeMD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Management and Outcomes of Pediatric Lymphatic Malformations: A Systematic Review From the APSA Outcomes and Evidence-Based Practice Committee
Infographic · Nov 2024 · 1 min read
In brief
In brief
This APSA systematic review of 202 studies found that pediatric lymphatic malformations respond well to multimodal treatment, with sclerotherapy achieving >90% response rates for macrocystic lesions and sirolimus serving as effective adjunctive therapy. A multidisciplinary approach tailored to lesion characteristics optimizes outcomes.
- Sclerotherapy achieves >90% partial or complete response and is most effective for macrocystic lymphatic malformations.
- Sirolimus can be used as adjunct therapy with procedures or as primary treatment for extensive lymphatic malformations.
- Multi-modal treatment tailored to lesion size, extent, location, and type (macro vs microcystic) optimizes outcomes.
- Multidisciplinary team approach is recommended to individualize treatment strategy for each patient.
- Current evidence for LM management is moderate quality; treatment decisions require case-by-case assessment.
Written by the GCMD Library team from the infographic.
The infographic uses a teal, gray, and yellow color scheme with three main sections. The top section displays study methodology details against a teal background. The middle section features medical illustrations including a petri dish with pipette and lymphatic vessel imagery on a gray background, with treatment information in colored text boxes. The bottom section contains the conclusion on a yellow banner. Medical institution logos and social media handles appear at the bottom.
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
Background: Significant variation in management strategies for lymphatic malformations (LMs) in children persists. The goal of this systematic review is to summarize outcomes for medical therapy, sclerotherapy, and surgery, and to provide evidence-based recommendations regarding the treatment.
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.