Women Planned for Immediate Lymphatic Reconstruction During Axillary Lymph Node Dissection Should Be Reconstructable:...

Area of Science:

• Oncology
• Plastic Surgery
• Lymphedema Research

Background:

• Immediate lymphatic reconstruction (ILR) during axillary lymph node dissection (ALND) is a strategy to reduce breast cancer-related lymphedema (BCRL).
• A significant challenge reported in the literature is the high incidence of
• non-reconstructable
• patients, where suitable lymphatics or veins are unavailable for reconstruction.
• This contrasts with experiences at institutions where reconstructable vessels are consistently found.

Purpose of the Study:

• To compare the incidence of
• non-reconstructable
• patients in published literature versus local experience.
• To identify factors contributing to reconstructability and propose methods to improve the success rate of ILR during ALND.

Main Methods:

• A systematic review of studies reporting on ILR during ALND and the rate of
• non-reconstructable
• cases was performed.
• A retrospective chart review of consecutive ALND/ILR cases at the University of Calgary was conducted.
• Data collected included patient demographics, cancer stage, node dissection details, and operative specifics to analyze factors influencing reconstructability.

Main Results:

• The systematic review identified 11 studies with 949 patients, reporting a 14% rate of
• non-reconstructable
• patients.
• The University of Calgary series of 68 cases showed a significantly lower rate of 5.9% (p=0.03) for
• non-reconstructable
• patients.
• Demographics and treatment details were similar between the reviewed studies and the local series, with the key difference being the continuous involvement of a plastic surgeon during the extirpative phase.

Conclusions:

• Coordinated plastic surgical involvement throughout the axillary lymph node dissection procedure is crucial.
• This collaborative approach appears to significantly decrease the rate of
• non-reconstructable
• patients for immediate lymphatic reconstruction.
• Optimizing reconstructability enhances the potential of ILR to prevent breast cancer-related lymphedema.