Efficacy of Immediate Lymphatic Reconstruction in Prevention of Breast Cancer Related Lymphedema

Abstract

INTRODUCTION: Breast cancer related lymphedema (BCRL) is a chronic condition resulting in the accumulation of interstitial fluid that can negatively affect the quality of life of breast cancer survivors. Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) is emerging as a technique for the prevention of BCRL, though definitive clinical studies are still underway. This study compared the incidence of BRCL in patients who received ILR and those who were not amenable to ILR at the time of ALND. METHODS: Patients, retrospectively identified through a prospectively maintained database, were referred to the Multidisciplinary Lymphedema clinic for ILR at the time of ALND between 2016 and 2021. At the time of surgery, some patients were deemed non-amenable to ILR due to a lack of visualized lymphatics or anatomic variability (e.g., spatial relationships or size discrepancies). Descriptive statistics for sociodemographic and clinical risk factors and complications of surgery were conducted, with significance determined by independent t test and Pearson’s χ2 test. Bivariate and multivariable logistic regression models were created to assess the association between lymphedema and ILR. To account for the high mismatch in the number of patients having undergone ILR and those who had not, a loose age-matched subsample was created for sub-analysis. RESULTS: 281 patients were included in this study (252 patients who underwent ILR and 29 patients who did not). The patients had a mean age of 53 ± 12 years and BMI of 28.6 ± 6.8 kg/m2. The incidence of developing lymphedema in patients with ILR was 4.8% compared to 24.1% in patients without ILR (p = 0.001). Patients who did not undergo ILR had significantly higher odds of developing lymphedema compared to those who had ILR (OR 6.4 [2.3 – 17.8], p < 0.001). When the patients were matched by age, the patients without ILR still had higher odds of getting lymphedema (OR 14.2 [2.6 – 77.9], p < 0.001). CONCLUSION: Our study showed that ILR was associated with a lower rate of BCRL. Further studies are needed to determine which factors place patients at highest risk of developing BCRL.