Treatment of isolated lymphatic malformation with the herbal medicine “Eppikajyutsuto” - retrospective multicenter study

Purpose This study aimed to evaluate the clinical efficacy of the herbal medicine Eppikajyutsuto (TJ-28) as monotherapy for isolated lymphatic malformations (LM) in pediatric patients. Methods A retrospective review was conducted on 33 LM patients treated with TJ-28 at three pediatric surgery departments between 2009 and 2023. All patients underwent ultrasound and/or magnetic resonance imaging before and after treatment. LM lesions were classified as macrocystic, microcystic, or mixed macro-microcystic based on the International Society for the Study of Vascular Anomalies classification. The LM area index (LAI) was calculated as the product of longitudinal width and depth (mm²), and the LAI ratio was defined as post-treatment LAI divided by pre-treatment LAI. Results The median age at treatment initiation was 20 months, with a median treatment duration of 12 months. Significant reductions in LAI were observed in macrocystic (n = 23; p < 0.001) and mixed (n = 8; p = 0.01) types, while microcystic LM (n = 2) showed no significant change (p = 0.525). The median LAI ratio was 0.36 for macrocystic, 0.41 for mixed macro-microcystic, and not improve for microcystic. Conclusions TJ-28 appears to be effective for reducing lesion size in macrocystic and mixed macro-microcystic LM. Level of evidence a prognosis study of level Ⅳ