Sunday, October 10, 2004

Recurrence of Cutaneous Lymphangioma after Surgical Resection. -its feature and manner-

Katsunori Niitsuma, MD, Mitsuo Hatoko, MD, PhD, Hideyuki Tada, MD, PhD, Aya Tanaka, MD, Satoshi Yurugi, MD, and Hiroshi Iioka, MD.

The authors studied the manner and characteristics of postoperative recurrence of cutaneous lymphangiomas. Between January of 1991 and December of 1998, the authors treated surgically 25 patients with cutaneous lymphangiomas. In all patients, the lesion had been noticed at birth to 14 years. The size of the lesions ranged from 0.5 to 10 cm. All 25 lymphangiomas were resected surgically as definitive treatment. At the operation, all lesions were thought to be resected without remaining the lesion. After resecting the lesion, the defect was closed primarily (18 sites) or the defect was covered with a musculocutaneous or skin flaps (7 sites). All 25 cutaneous lymphangiomas were categorized into three types according to the classification of Flanagan; superficial lymphangiomas, deep lymphangiomas, and mixed type lymphangiomas. Among these categories, 9 (36%) of the tumors were diagnosed superficial lymphangioma, 10 (40%) deep lymphangioma, and 6 (24%) mixed type lymphangioma. Eight (32%) of 25 patients developed a recurrence during follow-up period. Seven patients performed additional surgery. The tumor size of the patients with recurrence was significantly larger than that of the patients without recurrence (p = 0.027, Mann-Whitney's U test). Among three types of lymphangiomas, the recurrence rate of mixed type lymphangiomas was higher than another two types of lymphangiomas (p = 0.026 and 0.035, respectively, Fisher's exact test). The recurrence rate in the group of the patients with lesion at birth was significantly higher than in the group of the patients without lesion at birth (p =0.001, Fisher's exact test). The interval from the age at onset to the first operation was significantly shorter in the patients without recurrence than in the patients with recurrence (p = 0.018, Mann-Whitney's U test). The recurrence occurred at early period after the operation, as the interval from the age at onset to the first operation became long. In the recurrent cases, there was a significant correlation between the two intervals; the interval from the age at onset to the first operation and the interval from the first operation to recurrence. (The correlation coefficient was 0.841). In conclusion, our study shows that the lesion must be resected as early as possible when noticing a lesion for preventing recurrence and invasive operation. Moreover, in taking great care to recurrence of the lesion after resecting lymphangiomas, the following are the points to be specially considered; recurrence rate is higher in mixed type lymphangiomas, recurrence is more likely to occur and tends to occur at early period after the operation when the interval from the time onset to the first operation is long, and the lesions in the patients with lesion at birth are more likely to occur.
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