The efficacy of immediate lymphatic reconstruction after axillary lymph node dissection - A meta-analysis

Breast cancer related lymphedema (BCRL) is a common complication following mastectomy and axillary lymph node dissection (ALND). Patients with BCRL are often fraught with restricted mobility of the upper limb and higher risk of infections which negatively impact their quality of life. Immediate lymphatic reconstruction (ILR) has gained popularity in recent years due to its positive results in lowering BCRL rates. The objective of this study is to summarize evidence from the current available literature on the efficacy of ILR in preventing BCRL following ALND. A comprehensive search across PubMed and Web of Science was conducted. Studies involving ILR performed at the time of ALND for breast cancer were included. Exclusion criteria included secondary lymphatic reconstruction for established BCRL, literature reviews, animal studies, case reports and studies detailing surgical technique. To evaluate the efficacy of ILR, only studies with both intervention groups (ILR) and control groups were included. A systematic search yielded data from 10 studies and 1487 breast cancer patients who underwent ALND at the time of surgery. Meta-analysis revealed that in the ILR group, 50 of 637 (7.85 %) patients developed BCRL whereas in the control group, 177 of 850 patients (20.8 %) developed BCRL. Patients treated with ILR in this analysis had a relative risk of 0.31 (95 % CI, 0.19 to 0.51) for developing BCRL when compared to the controls (p < 0.0001). ILR decreases the risk of developing lymphedema following ALND for breast cancer.