Surgical treatment of perineal lymphatic malformations: a single-center retrospective study of 24 years.

Purpose: To evaluate the long-term outcomes and recurrence patterns of surgical treatment for perineal lymphatic malformations (LMs), which are rare but functionally and cosmetically disabling.

Methods: We conducted a retrospective review of 19 patients with perineal LMs who underwent surgical excision between 2000 and 2024. All patients were followed for at least 1 year. Clinical presentation, surgical details, complications, and recurrence were analyzed. Recurrence-free survival was estimated using the Kaplan-Meier method, and risk factors were explored using univariate analysis.

Results: The cohort included 17 males and 2 females. Lesions were primarily located on the penis and scrotum; Symptoms included local swelling, disfigurement, cutaneous masses, lymphostatic elephantiasis, pain, skin discoloration, and functional compromise. No patients underwent surgery at 0-1 year of age, 6 were treated at 1-6 years, 1 at 6-12 years, 6 at 12-18 years, and 6 as adults (>18 years). The median follow-up duration was 12 years (range: 1-24 years). All skin grafts and flaps survived, and patient-reported functional and cosmetic outcomes improved significantly. The complication rate was 26.3%, including wound dehiscence, lymphatic leakage, and hypertrophic scars. Overall patient satisfaction was 84.2%. Primary surgical success (no recurrence after one procedure) was achieved in 63.2% of cases. Seven patients experienced recurrence. The estimated 20-year recurrence-free survival was 42.3%. Lymphostatic elephantiasis was significantly associated with recurrence (p<0.05).

Conclusion: Surgical excision of perineal LMs is safe and effective. Most patients achieved lasting symptom relief and cosmetic benefits after one operation. However, recurrence is a long-term concern, highlighting the need for ongoing surveillance.