Immediate lymphatic reconstruction with targeted lymphatic axillary repair

Area of Science:

• Surgical Oncology
• Lymphedema Research
• Breast Cancer Management

Background:

• Established lymphedema treatment is often challenging and lacks consistent success.
• Post-operative lymphedema is a significant complication following breast cancer surgery and axillary lymph node dissection (ALND).

Purpose of the Study:

• To evaluate the effectiveness of targeted lymphatic axillary repair (TLAR) in reducing the incidence of post-operative lymphedema.
• To assess TLAR as a method for immediate lymphatic reconstruction in breast cancer patients undergoing ALND.

Main Methods:

• An observational prospective study involving 50 breast cancer patients undergoing ALND between March 2017 and May 2022.
• Patients considered for TLAR received simultaneous lymphedema risk-reducing surgery.
• Follow-up included medical physiotherapist monitoring for a minimum of 18 months and indocyanine green lymphography.

Main Results:

• Only 2 out of 50 patients (4%) developed lymphedema during the follow-up period (mean 18.2 months).
• An average of 2.18 lymphatics were identified and 1.84 lymphaticovenous anastomoses were performed per patient.
• The majority of patients received neoadjuvant chemotherapy (68%) and adjuvant axillary radiotherapy (82%).

Conclusions:

• Targeted lymphatic axillary repair (TLAR) is a safe, effective, and physiologic surgical technique.
• TLAR demonstrates significant potential in reducing lymphedema risk for breast cancer patients post-ALND.