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. 2021 Mar;28(3):1381-1387.
doi: 10.1245/s10434-020-09104-2. Epub 2020 Sep 9.

Immediate Lymphatic Reconstruction after Axillary Lymphadenectomy: A Single-Institution Early Experience

Julia A Cook  1 , Sarah E Sasor  2 , Scott N Loewenstein  1 , Will DeBrock  1 , Mary Lester  1 , Juan Socas  1 , Kandice K Ludwig  3 , Carla S Fisher  1 , Aladdin H Hassanein  4
Affiliations

Immediate Lymphatic Reconstruction after Axillary Lymphadenectomy: A Single-Institution Early Experience

Julia A Cook et al. Ann Surg Oncol. 2021 Mar.

Abstract

Purpose: Lymphedema is progressive arm swelling from lymphatic dysfunction which can occur in 30% patients undergoing axillary dissection/radiation for breast cancer. Immediate lymphatic reconstruction (ILR) is performed in an attempt decrease the risk of lymphedema in patients undergoing axillary lymph node dissection (ALND). The purpose of this study was to assess the efficacy of ILR in preventing lymphedema rates in ALND patients.

Methods: An institutional review board-approved retrospective review was performed of all patients who underwent ILR from 2017 to 2019. Patient demographics, comorbidities, operative and pathologic findings, number of LVAs, limb measurements, complications, and follow-up were recorded and analyzed. Student's sample t-test, Fisher's exact test, and ANOVA were used to analyze data; significance was set at p < 0.05.

Results: Thirty-three patients were included in this analysis. Three patients (9.1%) developed persistent lymphedema, and two patients (6.1%) developed transient arm edema that resolved with compression and massage therapy. A significant effect was found for body mass index and the number of lymph nodes taken on the development of lymphedema (p < 0.01).

Conclusions: The rate of lymphedema in this series was 9.1%, which is an improvement from historical rates of lymphedema. Our findings support ILR as a technique that potentially decreases the incidence of lymphedema after axillary lymphadenectomy. Obesity and number of lymph nodes removed were significant predictive variables for the development of lymphedema following LVA.

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