Comparative Analysis of Minimally Invasive Therapeutic Strategies for Post-Surgical Pelvic and Retroperitoneal Lymphoceles

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Abstract
Background/Objective: Pelvic and retroperitoneal lymphoceles remain a clinically significant complication following pelvic surgery. The optimal minimally invasive management strategy continues to be a matter of debate. The objective of this study is to compare daily catheter drainage and catheter length of stay after percutaneous catheterization in patients with iatrogenic pelvic lymphocele who undergo sclerotherapy alone versus sclerotherapy with intranodal lymphangiography and lymphatic embolization (INL–LE). Methods: A total of 47 patients (55 lymphoceles) who developed symptomatic pelvic or retroperitoneal lymphoceles after oncologic pelvic surgery were retrospectively reviewed between September 2020 and April 2023. They were divided into two groups, one treated with sclerotherapy alone (24 lesions) and the other with sclerotherapy combined with INL–LE (31 lesions). The duration of catheter placement, daily drainage volume during sclerotherapy, lymphocele volume, and catheter dwell time subsequent to lymphatic embolization were compared between the two groups. Results: Of the 55 lymphoceles, 31 were treated with sclerotherapy plus lymphangiography/embolization (INL–LE group), whereas 24 lymphoceles were treated with sclerotherapy alone. Baseline characteristics were not different between the groups. Although initial drainage was higher in the INL–LE group, third-day drainage volume, the number of sclerotherapy sessions, and catheter dwell time were all significantly lower compared with the sclerotherapy group (all p < 0.001). Lesion size positively correlated with drainage volume and catheter duration, whereas embolization negatively correlated with drainage volume, the number of sessions, and catheter duration. Based on multivariate analysis, the addition of INL–LE was independently associated with a significantly shorter catheter dwell time (β = −0.803, p = 0.001). Conclusions: In this retrospective cohort, the addition of lymphatic embolization to sclerotherapy was associated with reduced drainage persistence and a shorter catheter dwell time compared with sclerotherapy alone.

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