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Multicenter Study
. 2024 Oct;31(11):7349-7359.
doi: 10.1245/s10434-024-15715-w. Epub 2024 Jul 2.

Lymphedema Rates Following Axillary Lymph Node Dissection With and Without Immediate Lymphatic Reconstruction: A Prospective Trial

James W Jakub  1 , Judy C Boughey  2 , Tina J Hieken  2 , Mara Piltin  2 , Antonio Jorge Forte  3 , Aparna Vijayasekaran  4 , Monica Mazur  5 , Jenna Sturz  2 , Kim Corbin  6 , Laura Vallow  7 , Jeffrey E Johnson  2 , Mary Mrdutt  2 , Vahe Fahradyan  4 , Zhuo Li  8 , Sophia Blumenfeld  8 , Amy Degnim  2 , Kathleen J Yost  9 , Andrea Cheville  10 , Sarah A McLaughlin  5
Affiliations
Multicenter Study

Lymphedema Rates Following Axillary Lymph Node Dissection With and Without Immediate Lymphatic Reconstruction: A Prospective Trial

James W Jakub et al. Ann Surg Oncol. 2024 Oct.

Abstract

Background: Immediate lymphatic reconstruction (ILR) has been proposed to decrease lymphedema rates. The primary aim of our study was to determine whether ILR decreased the incidence of lymphedema in patients undergoing axillary lymph node dissection (ALND).

Methods: We conducted a two-site pragmatic study of ALND with or without ILR, employing surgeon-level cohort assignment, based on breast surgeons' preferred standard practice. Lymphedema was assessed by limb volume measurements, patient self-reporting, provider documentation, and International Classification of Diseases, Tenth Revision (ICD-10) codes.

Results: Overall, 230 patients with breast cancer were enrolled; on an intention-to-treat basis, 99 underwent ALND and 131 underwent ALND with ILR. Of the 131 patients preoperatively planned for ILR, 115 (87.8%) underwent ILR; 72 (62.6%) were performed by one breast surgical oncologist and 43 (37.4%) by fellowship-trained microvascular plastic surgeons. ILR was associated with an increased risk of lymphedema when defined as ≥10% limb volume change on univariable analysis, but not on multivariable analysis, after propensity score adjustment. We did not find a statistically significant difference in limb volume measurements between the two cohorts when including subclinical lymphedema (≥5% inter-limb volume change), nor did we see a difference in grade between the two cohorts on an intent-to-treat or treatment received basis. For all patients, considering ascertainment strategies of patient self-reporting, provider documentation, and ICD-10 codes, as a single binary outcome measure, there was no significant difference in lymphedema rates between those undergoing ILR or not.

Conclusion: We found no significant difference in lymphedema rates between patients undergoing ALND with or without ILR.

Keywords: Breast cancer; Breast cancer-related lymphedema (BCRL); LYMPHA; Lymphaticovenous anastomosis; Lympho-venous bypass; Radiation.

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References

    1. Forte AJ, Sisti A, Huayllani MT, et al. Lymphaticovenular anastomosis for breast cancer-related upper extremity lymphedema: a literature review. Gland Surg. 2020;9(2):539–44. - DOI - PubMed - PMC
    1. Boccardo F, Casabona F, De Cian F, et al. Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy. Ann Surg Oncol. 2009;16:703–8. - DOI - PubMed
    1. Ozmen T, Lazaro M, Zhou Y, Vinyard A, Avisar E. Evaluation of simplified lymphatic microsurgical preventing healing approach (S-LYMPHA) for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection. Ann Surg. 2019;270(6):1156–60. - DOI - PubMed
    1. McEvoy MP, Gomberawalla A, Smith M, et al. The prevention and treatment of breast cancer- related lymphedema: a review. Front Oncol. 2022;6(12):1–12.
    1. Fraser Hill WK, Deban M, Platt A, Rojas-Garcia P, Jost E, Temple-Oberle C. Immediate Lymphatic reconstruction during axillary node dissection for breast cancer: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2022; 9;10(5):e4291.

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