Journal Article

Lymphedema Rates Following Axillary Lymph Node Dissection With and Without Immediate Lymphatic Reconstruction: A Prospective Trial

Degnim, Amy, Corbin, Kim, Vallow, Laura, Piltin, Mara, Yost, Kathleen J., Johnson, Jeffrey E., Mrdutt, Mary, McLaughlin, Sarah A., Cheville, Andrea, Jakub, James W., Li, Zhuo, Blumenfeld, Sophia, Sturz, Jenna, Fahradyan, Vahe, Vijayasekaran, Aparna, Hieken, Tina J., Mazur, Monica, Boughey, Judy C., Forte, Antonio Jorge

2024

Overview

Background Immediate lymphatic reconstruction (ILR) has been proposed to decrease lymphedema rates. The primary aim of our study was to determine whether ILR decreased the incidence of lymphedema in patients undergoing axillary lymph node dissection (ALND). Methods We conducted a two-site pragmatic study of ALND with or without ILR, employing surgeon-level cohort assignment, based on breast surgeons’ preferred standard practice. Lymphedema was assessed by limb volume measurements, patient self-reporting, provider documentation, and International Classification of Diseases, Tenth Revision (ICD-10) codes. Results Overall, 230 patients with breast cancer were enrolled; on an intention-to-treat basis, 99 underwent ALND and 131 underwent ALND with ILR. Of the 131 patients preoperatively planned for ILR, 115 (87.8%) underwent ILR; 72 (62.6%) were performed by one breast surgical oncologist and 43 (37.4%) by fellowship-trained microvascular plastic surgeons. ILR was associated with an increased risk of lymphedema when defined as ≥10% limb volume change on univariable analysis, but not on multivariable analysis, after propensity score adjustment. We did not find a statistically significant difference in limb volume measurements between the two cohorts when including subclinical lymphedema (≥5% inter-limb volume change), nor did we see a difference in grade between the two cohorts on an intent-to-treat or treatment received basis. For all patients, considering ascertainment strategies of patient self-reporting, provider documentation, and ICD-10 codes, as a single binary outcome measure, there was no significant difference in lymphedema rates between those undergoing ILR or not. Conclusion We found no significant difference in lymphedema rates between patients undergoing ALND with or without ILR.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adult / Aged / Axilla / Breast cancer / Breast Neoplasms - pathology / Breast Neoplasms - surgery / Breast Oncology / Female / Follow-Up Studies / Humans / Lymph Node Excision - adverse effects / Lymph nodes / Lymph Nodes - pathology / Lymph Nodes - surgery / Lymphatic system / Lymphedema / Lymphedema - etiology / Medicine / Medicine & Public Health / Microvasculature / Middle Aged / Oncology / Patients / Plastic Surgery Procedures - adverse effects / Plastic Surgery Procedures - methods / Postoperative Complications - etiology / Prognosis / Prospective Studies / Statistical analysis / Surgeons / Surgery / Surgical Oncology