Thirteen Years of Immediate Lymphatic Reconstruction (ILR) for the Prevention of Lymphedema: A Meta-analysis of Prospective Clinical Trials

Background:  Despite the growing use of immediate lymphatic reconstruction (ILR) for preventing lymphedema, prospective long-term data on its efficacy remain limited. This study aims to analyze long-term, prospective outcomes of ILR, utilizing all available outcome measures. 

Methods:  Outcome data included the pooled cumulative incidence of lymphedema (assessed by limb measurements), odds ratio (OR), and relative risk (RR) for lymphedema development in patients who underwent ILR versus those who did not. Only prospective clinical trials with a minimum of 12 months of follow-up were included. 

Results:  Nine prospective studies (2011–2024) were included, totaling 791 patients, with 460 undergoing ILR and an average follow-up of 20.6 ± 4.8 months. On average, 1.9 ± 0.4 anastomoses were performed per patient. ILR was associated with a significantly lower incidence of lymphedema: 9% (95% CI: 1% – 16%) compared to 29% (95% CI: 11% – 46%) in the non-ILR group. Patients who received ILR had 69% lower odds of developing lymphedema compared to those without ILR (OR = 0.31, 95% CI: 0.19 – 0.51). A 58% reduction in lymphedema risk was also observed among ILR recipients (RR = 0.42, 95% CI: 0.26 – 0.68). 

Conclusion:  This meta-analysis, summarizing thirteen years of prospective data, is the largest study to evaluate the long-term efficacy of ILR in lymphedema prevention. The findings demonstrate that ILR significantly reduces the incidence, odds, and risk of lymphedema, supporting its role as an effective preventive strategy in at-risk patients.