Efficacy of Immediate Lymphatic Reconstruction in Prevention of Breast Cancer–Related Lymphedema

Abstract

Introduction Breast cancer–related lymphedema (BCRL) is a chronic condition that can negatively affect the quality of life of breast cancer survivors. Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection is emerging as a technique for the prevention of BCRL. This study compared the incidence of BRCL in patients who received ILR and those who were not amenable to ILR. Methods Patients were identified through a prospectively maintained database between 2016 and 2021. Some patients were deemed nonamenable to ILR due to a lack of visualized lymphatics or anatomic variability (eg, spatial relationships or size discrepancies). Descriptive statistics, independent t test, and Pearson χ2 test were used. Multivariable logistic regression models were created to assess the association between lymphedema and ILR. A loose age-matched subsample was created for subanalysis. Results Two hundred eighty-one patients were included in this study (252 patients who underwent ILR and 29 patients who did not). The patients had a mean age of 53 ± 12 years and body mass index of 28.6 ± 6.8 kg/m2. The incidence of developing lymphedema in patients with ILR was 4.8% compared with 24.1% in patients who underwent attempted ILR without lymphatic reconstruction (P = 0.001). Patients who did not undergo ILR had significantly higher odds of developing lymphedema compared with those who had ILR (odds ratio, 10.7 [3.2–36.3], P < 0.001; matched OR, 14.2 [2.6–77.9], P < 0.001). Conclusions Our study showed that ILR was associated with lower rates of BCRL. Further studies are needed to determine which factors place patients at highest risk of developing BCRL.

Immediate Lymphatic Reconstruction in 77 Consecutive Breast Cancer Patients: 2-year Follow-up

“…To date, of the 411 patients that we have attempted ILR, we were unable to complete ILR in 52 patients (12.7%) due to a lack of visualized lymphatics or anatomic variability (e.g., spatial relationships or size discrepancies). 17…”

“…To date, of the 411 patients that we have attempted ILR, we were unable to complete ILR in 52 patients (12.7%) due to a lack of visualized lymphatics or anatomic variability (e.g., spatial relationships or size discrepancies). 17 In the clinic, regular monitoring of patients with a dedicated team including a certified plastic surgery nurse (CPSN), a certified lymphatic therapist (CLT), dietician and plastic surgeon helps to detect and manage any subclinical/early-stage disease. This affords the opportunity to optimize the results of secondary surgical interventions to treat BCRL should the need arise.…”

The Impact of Obesity on Success of Immediate Lymphatic Reconstruction for Prevention of Breast Cancer–Related Lymphedema

“…Reported rates of lymphedema following ILR are significantly lower than the cohort without intervention, in the range of 3%-12% compared with a historic 20%-40%. 2,[4][5][6][7][8] Recently published preliminary results of a randomized controlled trial are promising and supportive of the meaningful impact ILR has on reducing the risk of BCRL. 9 Despite our progress in the field with retrospective institutional studies, systematic reviews, meta-analysis, and randomized controlled trials underway, relatively little is known about factors that may contribute to procedural failure or the protective nature this intervention has on high-risk patients despite other high-risk comorbidities.…”

“…Literature suggests this may impact up to 40% of high-risk breast cancer survivors. [1][2][3] Breast cancer-related lymphedema is a life-altering diagnosis following cancer treatment and imparts a significant, multidimensional impact on patients. Avariety of therapeutic treatment modalities exist, which include complete decongestive and compression therapy for symptomatic improvement.…”

Immediate lymphatic reconstruction for breast cancer-related lymphedema: current status and challenges

“…Some retrospective studies of the effectiveness of ILR have recently been published ( 4 , 5 ). In a recent report with a relatively large number of cases, Le et al reported that in 252 patients treated with ILR, BCRL occurred in 4.8% of patients, compared with 24.1% in 29 patients not treated with ILR, indicating that ILR was effective in preventing BCRL ( 6 ). Hill et al also conducted a systematic review and meta-analysis of the efficacy of ILR for BCRL.…”