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

James W Jakub1, Judy C Boughey2, Tina J Hieken2

  • 1Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA. Jakub.james@mayo.edu.

Annals of Surgical Oncology
|July 2, 2024
PubMed
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This summary is machine-generated.

Immediate lymphatic reconstruction (ILR) did not significantly reduce lymphedema rates after axillary lymph node dissection (ALND) in breast cancer patients. This study found no difference in lymphedema incidence between patients who did and did not receive ILR.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Lymphedema Research

Background:

  • Axillary lymph node dissection (ALND) is a standard procedure for breast cancer staging.
  • Lymphedema is a common and debilitating complication following ALND.
  • Immediate lymphatic reconstruction (ILR) has been proposed as a method to mitigate lymphedema incidence.

Purpose of the Study:

  • To evaluate the efficacy of immediate lymphatic reconstruction (ILR) in reducing the incidence of lymphedema after axillary lymph node dissection (ALND).

Main Methods:

  • A two-site pragmatic study design was employed, assigning surgeons based on their preferred practice (ALND with or without ILR).
  • Lymphedema assessment included limb volume measurements, patient self-reporting, provider documentation, and ICD-10 codes.
Keywords:
Breast cancerBreast cancer-related lymphedema (BCRL)LYMPHALymphaticovenous anastomosisLympho-venous bypassRadiation

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  • Intention-to-treat analysis was performed on 230 breast cancer patients.

    • Main Results:

    • No statistically significant difference in lymphedema rates was observed between the ALND with ILR group and the ALND alone group.
    • Multivariable analysis, after propensity score adjustment, did not show ILR to be associated with an increased risk of lymphedema.
    • Analysis of limb volume changes (≥5% or ≥10%) and clinical grading did not reveal significant differences between the surgical approaches.

    Conclusions:

    • Immediate lymphatic reconstruction (ILR) does not significantly alter lymphedema rates in patients undergoing axillary lymph node dissection (ALND).
    • Current evidence does not support the routine use of ILR to prevent lymphedema after ALND.