Immediate lymphatic reconstruction for breast cancer-related lymphedema prevention: A systematic review

Breast cancer related lymphedema (BCRL) is a complication of breast cancer treatment, affecting 10-56% of women who undergo axillary lymph node dissection. Immediate lymphatic reconstruction (ILR) is an emerging intervention to reduce the risk of lymphedema development at the time of axillary lymph node dissection. This study assesses the current body of evidence on ILR, with specific focus on efficacy in preventing breast cancer-related lymphedema, operative technique, and its safety profile. PubMed, Embase, and Cochrane databases were queried for studies on ILR published up to September 30, 2024. Studies involving lymphatic reconstruction after the development of BCRL were excluded. The systematic review identified 18 studies, 16 focusing on BCRL development and 2 focusing on oncologic recurrence outcomes. Of 785 patients receiving ILR, the cumulative BCRL rate was 13.3% with a median follow-up time of 15 months. Of 696 control group patients, the cumulative BCRL rate was 26.1% at a median follow-up time of 14.6 months. BCRL rates were higher in both groups in studies with longer follow-up times. This systematic review revealed an overall relative risk (RR) of 0.51 of developing BCRL in patients receiving ILR after axillary lymph node dissection. The RR was 0.33 in studies with a follow-up duration of fewer than 18 months and 0.60 in those with longer follow-up periods. Newer studies have included longer follow-up times and the inclusion of control groups, allowing for better evaluation of the long-term efficacy of ILR. This study also highlighted areas of focus for future study, including standardization of technique and lymphedema diagnosis, oncologic safety, and patient-reported outcomes.