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Who Gets Immediate Lymphatic Reconstruction? A Systematic Review of Racial and Ethnic Representation in Lymphedema Preventive Surgery Trials
Morgan Cody
1, Michael Mazarei
1, Carolyn De La Cruz
1
1. Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
Background: Cancer-related lymphedema is a chronic, debilitating complication of oncologic surgery that impairs function and quality of life. As there remains no cure, strategies that prevent its onset have become a priority in cancer care, such as immediate lymphatic reconstruction (ILR). However, there is a lack of high-level evidence on reporting and representation of racial and ethnic data in ILR trials. Thus, this study aims to systematically evaluate the racial and ethnic composition of ILR participants.
Methods: Three databases were queried for studies including patients undergoing ILR up to January 2026. We excluded non-ILR interventions. A systematic review was performed to analyze race and ethnicity reporting in ILR cohorts and compared across study design. Two reviewers independently screened articles, extracted data, and assessed risk of bias.
Results: We identified 80 unique ILR studies, including 66 breast cancer-related and 14 pelvic/lower-extremity. 21 (26.9%) reported race for ILR recipients, and 14 (17.5%) reported ethnicity as a separate variable. All studies with race or ethnicity data were conducted in the United States. Across the 21 ILR cohorts with usable race data (2,159 ILR recipients), pooled representation was 75.4% White (n=1,627), 12.0% Black (n=259), 4.6% Asian (n=99), and 4.3% other or mixed race (n=92). Among the 14 cohorts (708 ILR recipients) that reported ethnicity separately, 6.7% (n=91) were Hispanic/Latino, 85.3% (n=1,151) were non-Hispanic, and 2.5% (n=34) were unknown. Additionally, in studies including a closely matched control group, the proportion of White patients was similar between the ILR and control groups, whereas the proportion of Black patients in the ILR group was less than half that observed in controls (8% vs 16.4%, p = 0.002).
Conclusions: Across published ILR/LYMPHA studies, race and ethnicity are frequently unreported and inconsistently defined. Lack of reporting risks entrenching inequities in access to preventive surgery, as well as limit evaluation of ILR outcomes across different racial populations.
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