Lymphangioma or lymphatic malformation includes a wide spectrum of abnormalities because it can be found in any region of the body and has a variety of appearances [1, 2, 3, 4]. Although pediatric surgeons occasionally encounter this disease, the incidence of lymphangioma is relatively low. This means that it takes a long time for surgeons to accumulate experience in the treatment of lymphangioma. Therefore, a nationwide study is helpful for surgeons to understand this disease and choose optimal treatment methods. The 2019 annual nationwide survey of the Korean Association of Pediatric Surgeons (KAPS) was on the subject of lymphangioma, and the results were first discussed at the annual meeting of KAPS in Gyeongju on June 13–14, 2019.

The authors reviewed and analyzed the clinical data of patients who started treatment for lymphangioma in KAPS members’ hospitals from 2011 to 2013. Their follow-up data were also included in the study. We used Microsoft Access 2016^® (Microsoft, Redmond, WA, USA) for patient registry and data collection. All the data were analyzed using the IBM SPSS version 23 statistical software package (IBM Co., Armonk, NY, USA).

Although lymphatic malformations can occur in any anatomic region, most clinical studies of lymphangioma, or lymphatic malformation, focus on lymphatic-rich areas, such as the head and neck, the axilla, and the mediastinum [3, 5, 6]. However, understanding the overall clinical characteristics of lymphangioma is important because the basic concepts in the treatment of lymphangioma are similar, regardless of the lesion site [2, 4]. The significance of this study lies not only in the fact that it is the first nationwide survey on lymphangioma in Korea but also in the fact that it integrates clinical characteristics and treatment results of patients with lymphangioma.

The results of this study are consistent with those of previous studies with respect to the most common locations of lesions, the major symptoms, the kinds of imaging studies, the types of appearances [1, 7], and favoring of OK-432 as a sclerosing agent [8, 9, 10]. However, in contrast with other studies, we included observation without other treatments as a method of treatment [6]. We believe that the benign characteristic of lymphangioma and the possibility of spontaneous regression makes observation a viable treatment option [11].

Among the treatment methods considered, the best results were obtained from operation, followed by sclerotherapy, co-treatment with operation and sclerotherapy, and observation. However, the correlation between the choice of treatment method and the difficulty of treatment should be considered when interpreting these results. The difficulty of treating lymphangioma generally varies significantly depending on whether it takes a simple or complex form [5, 12]. We think it was possible that we avoid the operation in complex form of lymphangioma, and non-operative treatment methods were selected as the preferred treatment method over operation. In this study, we did not distinguish between simple and complex forms of lymphangioma, which is one of the limitations of this study.

Other limitations are that we did not include long-term follow-up results, and we did not compare results according to the area where the lesion occurred. These issues should be addressed in future studies. Despite its limitations, this study provides general information on lymphangioma and comprehensive treatment outcomes. Therefore, we expect it will be an important reference for pediatric surgeons seeking to better understand lymphangioma and treatment options for this disease and that it will ultimately lead to better outcomes.