Establishment and Feasibility of an Immediate Lymphatic Reconstruction Program in a Community Health System

Area of Science:

• Oncology
• Surgical Innovation
• Lymphedema Research

Background:

• Breast cancer-related lymphedema (BCRL) is a common post-surgical complication.
• Immediate lymphatic reconstruction (ILR) shows promise in preventing BCRL.
• Evaluating ILR in a community health system is crucial as most care occurs outside academic centers.

Purpose of the Study:

• To assess the effectiveness of a preventative lymphedema program using ILR in a community health setting.
• To compare lymphedema rates after ILR with historical data from patients who did not undergo ILR.
• To identify factors influencing ILR success and post-operative lymphedema development.

Main Methods:

• A prospective database of patients undergoing ALND with attempted ILR (2019-2021) was retrospectively reviewed.
• A historical benchmark lymphedema rate was established from patients undergoing ALND without ILR (2011-2021).
• Statistical analysis compared outcomes between successful and aborted ILR, and against the historical benchmark.

Main Results:

• Immediate lymphatic reconstruction (ILR) was successful in 76.7% of 90 patients.
• Successful ILR significantly reduced lymphedema rates (10.9%) compared to aborted ILR (66.7%) and the historical benchmark (50.2%).
• Factors like smoking, higher BMI, and fewer lymphatic channels were associated with ILR abortion; older age was linked to lymphedema post-successful ILR.

Conclusions:

• Successful immediate lymphatic reconstruction (ILR) after axillary lymph node dissection (ALND) is effective in reducing breast cancer-related lymphedema (BCRL).
• The findings support the feasibility and efficacy of implementing ILR programs within community health systems.
• This approach offers a viable strategy for BCRL prevention in broader clinical settings.