Immediate Lymphatic Reconstruction Effectively Prevents Lymphedema: A Meta-Analysis of Outcomes and Risk Factors

Immediate lymphatic reconstruction (ILR) following axillary lymph node dissection (ALND) has emerged as a potential strategy to mitigate breast cancer-related lymphedema (BCRL). This present study aims to evaluate the impact of ILR on lymphedema incidence in breast cancer patients undergoing ALND and identify potential risk factors for lymphedema despite ILR.

A comprehensive search was performed using PubMed, Embase, Scopus, Ovid and Google Scholar databases. Thirty studies met inclusion criteria for the meta-analysis, comprised of seventeen comparative studies and thirteen non-comparative studies. The primary outcome was the incidence of lymphedema.

Overall, there was a 63% reduction in lymphedema risk with ILR. Among 1030 patients who underwent ILR, 14.5% developed lymphedema, compared to 25% of the 1260 patients in the control group. When pooling all ILR patients (including non comparative studies) across studies (n = 2080), 11% developed lymphedema. While BMI and the number of lymph nodes removed showed trends toward increased lymphedema risk in the ILR group, neither reached statistical significance (p > 0.05). There was significant variability among studies in terms of follow-up, post-operative management, and metrics for determining lymphedema. Notably, studies with longer follow-up reported higher lymphedema rates.

ILR is associated with a reduction in BCRL risk following ALND. Despite heterogeneity and risk of bias across studies, the meta-analysis suggests a favorable effect of ILR. Future studies should adopt standardized diagnostic criteria and assessment tools for lymphedema to enhance comparability and reduce heterogeneity.