Is Immediate Lymphatic Reconstruction on Breast Cancer Patients Oncologically Safe? A Preliminary Study

Abstract

Background: In breast cancer patients receiving axillary lymph node dissection (ALND), immediate lymphatic reconstruction (ILR) with lymphovenous anastomosis is an emerging technique for reducing the risk of arm lymphedema. However, the oncologic safety of surgically diverting lymphatic ducts directly into venules in a node-positive axilla is still a concern of inadvertently inducing metastasis of remaining cancer cells. This study aimed to assess the oncologic safety of ILR. Methods: From January 2020 to January 2022, 95 breast cancer patients received ALND, and 45 of them also received ILR. Patients with recurrent cancer, with follow-up less than 12 months, and with missed data were excluded. Variables were compared between ILR and non-ILR groups, and the outcome of interest was the rate of distant recurrence after follow-up for at least 1 year. Results: Thirty-four patients in the ILR group and 32 patients in the non-ILR group fulfilled the inclusion criteria for analysis. No statistically significant difference was noted between groups in terms of age, body mass index, type of breast surgery, pathologic cancer staging, histologic type and grade of breast cancer, molecular subtypes, frequency of axillary lymph node metastasis, or adjuvant therapy. For the patients receiving follow-up for at least 1 year, no statistically significant difference was found in terms of distant recurrence rates between ILR and non-ILR groups (P = 0.44). Conclusion: For breast cancer patients receiving ALND, ILR with lymphovenous anastomosis is oncologically safe, within an average follow-up period of 21 months.

Distally Based Lymphatic Microsurgical Preventive Healing Approach—A Modification of the Classic Approach

“…Remnant microscopic disease may be left behind along these afferent channels due to the proximity to axillary nodes. We are unable to reliably compare the oncologic safety between LYMPHA and dLYMPHA due to the paucity of long-term data, 12,13 but by performing the LVAs distal to the axilla, we can safely avoid any theoretical iatrogenicity in cancer recurrence while providing similar rates of lymphedema incidence (3.84%, p ¼ 0.018).…”

A promising step forward: early results from a randomized clinical trial support the efficacy of immediate lymphatic reconstruction following axillary lymph node dissection

“…This represents a risk ratio of 0.22 and a number needed to treat of 4 ( 2 ). ILR has also recently been shown to be oncologically safe, as well as cost effective ( 6 , 7 ). These promising early studies have sparked ongoing interest in the procedure and the need for further research into its efficacy, particularly in the form of a randomized clinical trial (RCT) which has not yet been presented in the literature.…”

Immediate lymphatic reconstruction for breast cancer-related lymphedema: current status and challenges

“…Another issue that was not discussed in this RCT was whether ILR increases lymph node metastasis and distant metastasis. Although a few publications regarding the oncological safety of ILR have been published ( 12 , 13 ), they were all retrospective studies, and obtaining high-level evidence about not only the efficacy of ILR, but also its oncological safety is required.…”