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Direct to Surgery? Surgical Outcomes in Pediatric Patients with Infantile Hemangioma: A Retrospective Case-Control Study
Katherine A. Grunzweig, MD; Nikita S. Goel, MD; Corinne Wee, MD; Anand R. Kumar, MD
University Hospitals Cleveland Medical Center
2019-01-30
Presenter: Katherine Grunzweig
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. All residents contributed to the original work. Grunzweig performed a significant portion of the original work of the project including conception, analysis and interpretation, and drafting, and Goel and Wee have had original contributions to the work.
Director Name: Anand Kumar
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Purpose: The effects of medical pre-treatment prior to surgical excision of infantile hemangiomas (IH) remains understudied. This study aimed to determine if there was a significant difference in surgical complications between direct to surgery and prior medical pre-treatment.
Methods: A retrospective chart review was conducted at a pediatric tertiary center between 2007-2018. Children 0-18 years who underwent surgical resection (confirmed GLUT-1 positive IH) were included. Visceral and congenital hemangiomas, PHACE and Kasabach-Merritt syndromes were excluded. Pre-treatment was the primary predictor for post-surgical complications. Literature meta-analysis was performed.
Results: Our institution identified 185 IH patients, 85 (46%) underwent surgical resection. Of these, 32.9% had pre-treatment (PT) (8.24% propranolol, 9.41% topical timolol, 12.94% steroids, 2.35% laser); 67.1% had no pre-treatment (NPT). Pre-surgical lesion size was comparable (p=0.829). Surgical outcomes between PT and NPT were comparable for wound dehiscence, infection, scarring, and repeat surgery (p=0.162, 1.0, 1.0, 0.483), including pooled complications (p=0.448). Where documented, PT had higher functional improvement (p=0.039). Results were comparable when selecting for beta-blockers versus NPT. Meta-analysis included 7 studies and 169 patients, 39.1% PT and 68.1% NPT. Most common PT was systemic/intralesional steroids. Five received beta-blockers. All patients had functional improvement where recorded. Complications were slightly higher for PT (p=0.041).
Conclusion: Incidence of surgical complications is comparable between direct to surgery and medical pre-treatment patients. This data supports early surgical management in appropriate patients and is a valid treatment arm in hemangioma protocols. Future directions include defining appropriate candidates for direct to surgery inclusion on our institution's treatment algorithm.
