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Immediate lymphatic reconstruction decreases the risk of lymphatic abnormalities in women who undergo axillary lymph node dissection for breast cancer treatment
Janet C. Coleman-Belin
*1, Jonathan Rubin
1, Lillian A. Boe
2, Richard Diwan
1, Jasmine J. Monge
1, Dinh-Do Dinh
1, Emily Bloomfield
1, Joseph Dayan
1, Babak J. Mehrara
1, Michelle Coriddi
11Section of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; 2Department of Epidemiology and Biostatistics,, Memorial Sloan Kettering Cancer Center, New York, NY
Background:Risk factors that increase the likelihood of developing lymphedema (LE) following axillary lymph node dissection (ALND) are based on varying and arbitrary cutoffs for LE diagnosis. This can decrease the reported LE incidence based on volume criteria due to reduced arm swelling with compression use. Therefore, perhaps instead of examining risk factors for development of LE, we should examine factors that contribute to normal lymphatic function. This study aims to identify protective factors associated with normal lymphatic function after ALND for treatment of breast cancer.
Methods:This was a prospective study of women treated with unilateral ALND for breast cancer at a tertiary cancer center 2020-23. The patients were randomized to a control arm or treated with immediate lymphatic reconstruction (ILR) at the time of ALND. Patients with normal lymphatic function were defined as meeting all of four criteria: <10% arm volume change from baseline, <10 bioimpedance change from baseline, no compression use, and stage 0 on ICG lymphography at one year follow up. All other patients were classified as having abnormal lymphatic function. Two sample T-test, Fisher's exact test, and Pearson's Chi- squared test compared group characteristics. Univariate and multivariate logistic regression examined variables possibly associated with normal lymphatic function.
Results:Of 112 patients with one year follow up, 34 patients (30.4%) had normal lymphatic function and 78 patients (69.6%) had abnormal lymphatic function. A higher percentage of patients underwent ILR in the normal lymphatic function group compared to the abnormal group (68% vs 42%, p=0.014). On univariate analysis, ILR was the only variable significantly associated with normal lymphatic function. The odds of normal lymphatic function in patients who had ILR were 3.10 times higher than that of patients who did not (OR=3.10, 95% CI=1.21 to 8.54, p=0.022).
Conclusion:ILR is significantly associated with normal lymphatic function one year after ALND and may be protective against developing breast cancer-related LE.
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