TREATMENT OUTCOMES OF LYMPHATIC MALFORMATION IN CHILDREN: BLEOMYCIN SCLEROTHERAPY VS. SURGICAL RESECTION

Abstract

Objective: To evaluate the effects of bleomycin-sclerotherapy against surgical resection for children with Lymphatic malformation.

Methodology: This prospective observational study was conducted at the Pediatric Surgery Unit, DHQ Teaching Hospital Timergara Lower Dir KPK, Pakisan in the duration from January 2022 to February 2024, involving 60 pediatric patients with lymphatic malformation. Participants, aged one month to fifteen years, were divided into two groups: Group A (n=30) underwent intralesional sclerotherapy with bleomycin, while Group B (n=30) underwent surgical excision. Demographic data including age, gender, and lymphangioma location were collected, with outcomes categorized as excellent (total resolution), good (>50% resolution), or poor (<50% resolution). Post-procedural complications and recurrence rates were evaluated at three and six months post-treatment. Statistical analysis using SPSS 23.0 included Student's t-tests and chi-square tests, with p<0.05 considered significant.

Results: This study investigated the efficacy of sclerotherapy versus surgical excision in 60 pediatric patients with lymphatic malformation, evenly split into Group A (sclerotherapy) and Group B (surgery). Demographic analysis revealed no significant differences in age distribution, with Group A averaging 4.3 years and Group B 4.1 years. Gender composition was similar, with Group A comprising 26.67% males and 23.33% females, and Group B with 25% males and 25% females. The distribution of lymphangioma sites also showed no significant differences between groups. Treatment outcomes were categorized into complete, partial, and poor resolution, with Group A achieving higher rates of complete resolution (76.7% vs. 46.7% in Group B) and Group B showing significantly higher rates of poor resolution (20.0% vs. 3.3% in Group A). Complication rates favored sclerotherapy, with no cases of recurrence or wound infection in Group A, compared to 16.7% recurrence and 13.3% wound infection rates in Group B. While trends suggest fewer complications with sclerotherapy, statistical significance was not reached (p = 0.052 for recurrence and p = 0.112 for wound infection).

Conclusion: Sclerotherapy using bleomycin emerges as a safe and effective treatment for pediatric lymphatic malformation, showing advantages over surgical resection with no observed cases of recurrence or wound infection. Our study highlights important differences between sclerotherapy and surgery in achieving complete, good, and poor resolutions, with sclerotherapy demonstrating notable efficacy in reducing less favorable outcomes.