Immediate Lymphatic Reconstruction after Axillary Lymphadenectomy: A Single-Institution Early Experience

Abstract

Purpose. Lymphedema is progressive arm swelling from lymphatic dysfunction which can occur in 30% patients undergoing axillary dissection/radiation for breast cancer. Immediate lymphatic reconstruction (ILR) is performed in an attempt decrease the risk of lymphedema in patients undergoing axillary lymph node dissection (ALND). The purpose of this study was to assess the efficacy of ILR in preventing lymphedema rates in ALND patients.Methods. An institutional review board-approved retrospective review was performed of all patients who underwent ILR from 2017 to 2019. Patient demographics, comorbidities, operative and pathologic findings, number of LVAs, limb measurements, complications, and followup were recorded and analyzed. Student's sample t-test, Fisher's exact test, and ANOVA were used to analyze data; significance was set at p \ 0.05. Results. Thirty-three patients were included in this analysis. Three patients (9.1%) developed persistent lymphedema, and two patients (6.1%) developed transient arm edema that resolved with compression and massage therapy. A significant effect was found for body mass index and the number of lymph nodes taken on the development of lymphedema (p \ 0.01).

Primary Prevention of Cancer-Related Lymphedema Using Preventive Lymphatic Surgery: Systematic Review and Meta-analysis

“…1 ). 5 14 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 An overview of each study is summarized in Supplementary Table S2 (available online only). Ten and six single-arm studies reporting outcomes of PLS for upper ( Supplementary Table S3 ; available online only) and lower ( Supplementary Table S4 ; available online only) extremity CRL were included, respectively.…”

Simultaneous Lymphatic Superficial Circumflex Iliac Artery Perforator Flap Transfer from the Zone 4 Region in Autologous Breast Reconstruction Using the Deep Inferior Epigastric Artery Perforator Flap: A Proof-of-Concept Study

“…Among many controversies regarding lymphedema treatment, a consensus has been reached that "the earlier, the better". Thus, the importance of immediate lymphatic reconstruction has recently been emphasized [16,17].…”

Outcomes analysis of microsurgical physiologic lymphatic procedures for the upper extremity from the United States National Surgical Quality Improvement Program

“…Our study found similarly low complication rates as previously published studies. (Chang, 2010; Chang et al, 2013; Chang et al, 2020; Cheng et al, 2018; Cook et al, 2021; Hassanein et al, 2020; Schaverien & Coroneos, 2019) However, most studies on lymphatic procedures are focused on outcomes specific to lymphedema rather than complications such as those tracked by NSQIP. Overall, lymphatic procedures have low 30‐day complication rates and are well tolerated by patients.…”

“…(Brorson & Svensson, 1998) Operative treatment includes excisional (skin/subcutaneous resection, liposuction) and physiologic procedures vascularized lymph node transfer (VLNT) and lymphovenous bypass (LVB). (Brorson, 2003; Carl et al, 2017; Chang et al, 2013; Cook et al, 2021; Cook & Hassanein, 2021; Dayes et al, 2013; Hassanein et al, 2020; Hassanein, Sacks, & Cooney, 2017; Hoffner et al, 2018; Schaverien et al, 2018; Silva & Chang, 2016) VLNT and LVB are both microsurgical physiologic procedures performed to enhance lymph transit in the affected extremity. (Chang et al, 2013) Improvement in limb volume and patient‐reported outcomes have been described (Boccardo et al, 2014; Carl et al, 2017; Coriddi et al, 2020; Klernäs et al, 2020; Raju & Chang, 2015) There is no consensus on timing of treatment, preferred operation, or the order of interventions between VLNT and LVB (Scaglioni et al, 2017).…”