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

Le, Nicole; Liu, Langfeier; Cruz, Rachel de Sá Barreto Luna Callou; Parikh, Jeegan; Rotatori, Robert; Wainwright, David J; Weinstein, Brielle; Tavares, Tina; Panetta, Nicholas J.

doi:10.1097/01.gox.0000898768.97738.0e

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“…2 11 12 13 A retrospective study of 77 breast cancer patients who underwent ILR after ALND were found to have a 10% incidence of BCRL at 2-year follow-up. 31 Breast cancer patients with unknown preoperative axillary involvement or clinically nonpalpable lymph nodes following NAC typically undergo sentinel/targeted lymph node surgery to assess tumor presence in the axilla. 24 ALND can either be performed immediately following intraoperative frozen pathology section demonstrating tumor within the sentinel lymph node or as a second operation following positive permanent pathology.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Operative Times for Intraoperative Conversion of Axillary Node Biopsy to Axillary Lymph Node Dissection with Immediate Lymphatic Reconstruction

Ahmed,

Hulsman,

Roth

et al. 2024

J Reconstr Microsurg

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Background Lymphedema can occur in patients undergoing axillary lymph node dissection (ALND) and radiation for breast cancer. Immediate lymphatic reconstruction (ILR) is performed to decrease the risk of lymphedema in patients after ALND. Some patients who ultimately require ALND are candidates for attempted sentinel lymph node biopsy (SLNB) or targeted axillary excision. In those scenarios, ALND can be performed (1) immediately if frozen sections are positive or (2) as a second operation following permanent pathology. The purpose of this study is to evaluate immediate ALND/ILR following positive intraoperative frozen sections to guide surgical decision-making and operative planning. Methods A single-center retrospective review was performed (2019–2022) for breast cancer patients undergoing axillary node surgery with breast reconstruction. Patients were divided into two groups: immediate conversion to ALND/ILR (Group 1) and no immediate conversion to ALND (Group 2). Demographic data and operative time were recorded. Results There were 148 patients who underwent mastectomy, tissue expander (TE) reconstruction, and axillary node surgery. Group 1 included 30 patients who had mastectomy, sentinel node/targeted node biopsy, TE reconstruction, and intraoperative conversion to immediate ALND/ILR. Group 2 had 118 patients who underwent mastectomy with TE reconstruction and SLNB with no ALND or ILR. Operative time for bilateral surgery was 303.1 ± 63.2 minutes in Group 1 compared with 222.6 ± 52.2 minutes in Group 2 (p = 0.001). Operative time in Group 1 patients undergoing unilateral surgery was 252.3 ± 71.6 minutes compared with 171.3 ± 43.2 minutes in Group 2 (p = 0.001). Conclusion Intraoperative frozen section of sentinel/targeted nodes extended operative time by approximately 80 minutes in patients undergoing mastectomy with breast reconstruction and conversion of SLNB to ALND/ILR. Intraoperative conversion to ALND adds unpredictability to the operation as well as additional potentially unaccounted operative time. However, staging ALND requires an additional operation.

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