Factors Associated With Escalation to Additional Treatment After Percutaneous Catheter Drainage of Symptomatic Pelvic and Inguinal Lymphoceles Following Oncologic Surgery

INTRODUCTION: To identify early post-drainage factors associated with escalation to additional treatment for postoperative symptomatic pelvic and inguinal lymphoceles. METHODS: This single-centre retrospective study included lymphoceles treated with percutaneous drainage between 2014 and 2024 after oncologic surgery. Lesions were classified into drainage-only and additional treatment groups; escalation was decided at the physicians' discretion without a standardized protocol. Only drainage volumes before initiation of additional treatment were analysed. Associations with escalation were assessed using generalized linear mixed models (GLMMs) with patient ID as a random effect. RESULTS: Of 61 lesions in 45 patients, 40 were managed with drainage alone, whereas 21 underwent additional treatment (sclerotherapy, n = 19; intranodal embolization, n = 2) at a median of 10 days after drainage. Median Day 2 drainage volume was higher in the additional treatment group (320 vs. 50 mL, p = 0.002). In the multivariable GLMM, Day 2 drainage volume was associated with escalation (odds ratio per 100 mL increase, 1.62; 95% confidence interval, 1.14-2.30; p = 0.008), whereas absence of infection was not. This association remained significant in a secondary analysis adjusted for CT-derived lymphocele volume. Persistent high-output drainage or insufficient reduction in drainage volume was the documented reason for additional treatment in 20 of 21 lesions. CONCLUSION: Higher Day 2 drainage volume, measured before additional treatment, was associated with subsequent escalation. Although this association may partly reflect physician decision-making, Day 2 drainage volume may help identify lesions warranting closer monitoring and earlier reassessment of the treatment strategy.