Lymphatic Leakage after Surgery for Neuroblastoma: A Rare Complication?

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, 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 amplification, LL was seen significantly more often than in patients without amplification status ( = 0.019). LL was also significantly correlated with extent of surgery ( = 0.005). Follow-up status and overall survival were significantly inversely associated with LL ( = 0.004 and  = 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 ( = 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.