title: Sclerotherapy with bleomycin versus surgical excision for extracervical cystic lymphatic malformations in children.
abstract: OBJECTIVE
  Sclerotherapy (ST) with bleomycin is an effective treatment for cervical cystic lymphatic malformations (LM) in children. However, its efficacy for treating extracervical cystic LM in children has not been investigated adequately. This retrospective study compares the efficacy of ST with surgery for treating extracervical cystic LM in children.
  
  
  METHODS
  The subjects of this study were children treated for extracervical cystic LM at our hospital between 1970 and 2013. We evaluated retrospectively the hospital records of these children for age, gender, presenting symptoms, location of the lesion, radiological findings, treatments, complications, duration of hospitalization, and outcome.
  
  
  RESULTS
  We analyzed the records of 70 children (M:F = 1:9) with a mean age of 52.57 ± 54.87 months (range 1-204 months). The number of children treated by surgery alone, ST alone, and surgery plus ST was 53 (77 %), 13 (18 %), and 4 (5 %), respectively. Surgery comprised total excision (n = 41), near-total excision (n = 9), partial excision (n = 6), and incisional biopsy (n = 1). The complication and recurrence rates were lower, the complete response rate was higher, and the length of hospitalization was shorter in the ST group than in the surgery group (5 vs. 15 % and 8 vs. 17 %, respectively, p < 0.05; 91 vs. 77 %, respectively, p = 0.05; and 2.42 ± 1.67 vs. 13.57 ± 16.24 days, respectively, p = 0.03).
  
  
  CONCLUSIONS
  ST is as safe as surgery for extracervical macrocystic or mixed LMs in children, but is much more effective with higher success rates and lower recurrence rates. Thus, ST provides a cost-effective and appropriate mode of treatment for children with extracervical cystic LM.
authors: Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
authors: Burak
authors: B
authors: Ardıçlı
authors: Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey. ikarnak@hacettepe.edu.tr.
authors: İbrahim
authors: İ
authors: Karnak
authors: Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
authors: Arbay Ö
authors: AÖ
authors: Çiftçi
authors: Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
authors: F Cahit
authors: FC
authors: Tanyel
authors: Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
authors: M Emin
authors: ME
authors: Şenocak
keywords: Bleomycin; Child; Cystic lymphatic malformation; Lymphangioma; Sclerotherapy