Lymphatic Leakage after Surgery for Neuroblastoma: A Rare Complication?

Abstract

Introduction Neuroblastoma is the most common extracranial solid tumor in infancy. It is responsible for around 15% of all oncological deaths during childhood. Due to its retroperitoneal location, neuroblastoma is invasively growing directly in and around the lymphatic duct. Consecutively, lymphatic leakage (LL) after surgery for neuroblastoma is a known complication. The purpose of this study is the investigation of frequency and impact of this complication. Material and Methods Between February 2003 and December 2016, 204 patients with neuroblastoma received surgical treatment in our department. A retrospective analysis for macroscopical extent of resection, duration of drainage postsurgery, maximum amount of fluid drained in 24 hours, MYCN amplification status, therapeutic options for LL, follow-up status, and overall survival was performed. Results A total of 40% of patients (82/204) showed LL to some extent. In patients with MYCN amplification, LL was seen significantly more often than in patients without MYCN amplification status (p = 0.019). LL was also significantly correlated with extent of surgery (p = 0.005). Follow-up status and overall survival were significantly inversely associated with LL (p = 0.004 and p = 0.0001). LL was self-limiting in all cases. There was a trend toward shorter duration of LL if either no special therapy was chosen or total parenteral nutrition (TPN) was administered (p = 0.0603). Conclusion We show that LL in neuroblastoma is a common complication of tumor resection and occurring more often than anticipated. Since, in our study cohort, all cases of LL were self-limiting, we question the indication for invasive therapy besides supporting measures.

Risk factors, impact and treatment of postoperative lymphatic leakage in children with abdominal neuroblastoma operated on by laparotomy

“…In recent years, there are many differences in the choice of treatment in some studies of lymphatic leakage after NB surgery. Froeba-Pohl [ 8 ] found that there was a trend toward shorter duration of lymphatic leakage if either no special therapy was chosen or TPN was administered. Qureshi [ 9 ] used fat-free/low-fat diet of MCT and Pio [ 11 ] used TPN with octreotide to treat lymphatic leakage.…”

“…S1 ). Although two studies on lymphatic leakage after NB surgery define major abdominal drainage (greater than 300 ml/day and 400 ml/day) as lymphatic leakage [ 8 , 10 ], there may be significant differences in the amount of drainage among children with different body weight. Therefore, this diagnostic criterion may not be suitable for all children.…”

“…Moreover, lymphatic leakage needs extra time to treat, resulting in prolonged time of abdominal drainage and hospitalization, which is very disadvantageous to children with NB who need chemotherapy after operation. Chemotherapy is usually carried out 3 weeks after operation [ 8 ]. This study found that 53.1% of the children with lymphatic leakage failed to start chemotherapy in time, which may affect the overall therapeutic effect.…”

“…Although lymphatic leakage is not as dangerous as bleeding and pancreatic fistula, long-term abdominal drainage will still adversely affect postoperative complications and follow-up treatment. It has been emphasized in previous articles [ 8 – 10 ] that chemotherapy or other systemic treatment of NB children with lymphatic leakage should not be delayed. Although there is a lack of clear recommended time for adjuvant chemotherapy after NB surgery, many studies have suggested that postoperative adjuvant chemotherapy should be carried out as early as possible [ 24 , 25 ].…”

“…It directly leads to an increase in abdominal drainage and prolongs the hospitalization time of some patients. Moreover, long-term lymphatic leakage and abdominal drainage may also cause some complications, affect postoperative chemotherapy, and even ultimately affect the prognosis [ 7 , 8 ]. Therefore, how to prevent and treat lymphatic leakage has become a problem to be solved in NB.…”