Trends in Immediate Lymphatic Reconstruction.

Abstract

Background and objective Immediate lymphatic reconstruction (ILR) is emerging as a useful adjunctafter axillary lymph node dissection (ALND), leading to a decrease in lymphedema rates from 30to 3-13% in breast cancer patients.ILR requires coordination between two surgical specialties for oncologic ALND and microsurgical axillary lymphatic anastomosis. This study aimed to assess the trends in the frequency of ILR performed after ALND at our institution. Methods This study involved aretrospective review of breast cancer patients undergoing ALND with and without ILRat our institution (2017-2022). Data on patient demographics, tumor characteristics, and treatments received were gathered and analyzed. Results A total of 316 patients underwent ALNDat our institution and 30.7% (97/316) of them received ILR. There was no significant difference in clinical breast cancer stages between patients who underwent ALND with or without ILR (p>0.05). Neoadjuvant chemotherapy was given to 51.1% (112/219) of patients with ALND only compared to 60.8% (59/97) of patients who underwent ALND with ILR (p=0.09). All patients received adjuvant radiation therapy. ILR was performed after ALND in 4.2% (2/47) in 2017, 25.8% (3/58) in 2018, 17.6% (12/68) in 2019, 35% (21/60) in 2020, 56.9% (41/72) in 2021, and 54.5% (6/11) in 2022. When comparing the first year of the ILR program with the last year of the study period, the odds ratio of receiving ILR after ALND was 1.8 (p=0.04). Conclusions The frequency of performing ILR after ALND in breast cancer patientsat our institution witnessed a substantial increaseduring the study period. The implementation of an established ILR program at an institution can increase procedure uptake accompanied by continued growth in utilization.