Immediate Lymphatic Reconstruction May Decrease the Incidence of Lymphedema in Patients Undergoing Axillary Lymph Node Dissection.

Abstract

Background: Approximately one-third of patients undergoing axillary lymph node dissection (ALND) for breast cancer will develop breast cancer-related lymphedema (BCRL). To prevent BCRL, immediate lymphatic reconstruction (ILR) has been proposed, whereby lymphatics cut during the ALND are anastomosed to adjacent veins to restore lymphatic drainage. As evidence for ILR grows, the aim of this study was to investigate its efficacy at our institution.

Methods: This prospective single-center study included 17 women undergoing ALND with ILR. Our primary outcome was the incidence of BCRL, diagnosed using a greater than 10% relative difference in arm volume. Use of compression therapy was also followed. Our secondary outcome was patient-reported outcome measures, determined by the validated Lymphedema Quality of Life (LYMQOL-Arm) survey. Postoperatively, patients were followed up at regular intervals for a minimum of 18 months.

Results: The median age of included patients was 49 (interquartile range [IQR] 46-58). The average follow-up time was 34.4 months (range 18-42 mo). Two patients met the criteria for BCRL. Patients with BCRL had a significantly higher median arm volume difference of 27.5% (IQR 21.8%-33.2%) versus 4.2% (IQR 1.6%-7%; P = 0.02). Three patients used compression to control symptoms. Patients without lymphedema scored better in several domains of the LYMQOL-Arm survey, including function, appearance, and overall quality of life; however, these results did not meet statistical significance.

Conclusions: ILR in patients undergoing ALND is associated with a low incidence of BCRL. Our study is one of the first to use patient-reported outcome measures to study ILR.