Immediate lymphatic reconstruction: outcomes of a single-institution initial experience
Leslie Kim, MD, Leslie McGrath, NP, Babak Mehrara, MD, Joseph Dayan, MD, Michelle Coriddi, MD
Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
Background: Immediate lymphatic reconstruction (ILR) is a promising technique for reducing risk of lymphedema after axillary lymph node dissection (ALND). However, most reports of this technique are limited by low numbers of patients and short follow-up times, and more data are needed. Our study aims to add this limited sample by describing our experience with ILR.
Methods: We conducted a retrospective review of all patients who underwent unilateral ILR after ALND from May 2019 to March 2020. Patient demographics, surgical details, follow up, and arm volume measurements were recorded. Patients with a greater than 10% volume difference between the affected limb and the contralateral limb were diagnosed with lymphedema.
Results: We identified 30 patients who underwent ILR in this timeframe. Average age was 49.9 (±10.6), average BMI was 26.3 (±6.4). Five patients had ALND for breast cancer recurrence in the axilla; these patients had previously undergone sentinel lymph node biopsy (SLNBx) from 1.5 to 8.5 years prior. An additional five had an initial negative SLNBx on frozen examination but were positive for cancer on permanent pathological examination and required completion ALND between 2 and 5 weeks after SLNBx. Most patients received post-operative radiation to the chest wall (n=28, 93%) and many received regional lymph node radiation (n=15, 50%), neoadjuvant chemotherapy (n=17, 57%), and adjuvant chemotherapy (n=16, 53%). There were 1.9 (±1.0) lymphovenous bypasses performed per patient. Patients who had no previous axillary surgery had an average of 2.1 (1.1) bypasses, while patients with prior axillary surgery had 1.6 (0.7) bypasses. This difference was not statistically significant (p=0.21). Four patients were excluded from final analysis (DVT, death, baseline lymphedema, outside follow-up). Average follow-up of the remaining 26 patients was 17.4 (±3.9) months, and two patients had developed lymphedema (7.7%).
Conclusions: At a follow-up of a year and a half, patients with ILR after ALND had a lymphedema rate of 7.7% compared to historical control rate of 17.6% at our institution. Furthermore, there is no difference in ability to perform ILR in the setting of previous axillary surgery. A randomized controlled study with longer term follow-up is needed to confirm these promising results.
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