241 posters, 10 topics, 7 sessions, 899 authors, 296 institutions
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The AAPS 103rd Annual Meeting 2025
May 24-27, 2025 | Austin, Texas
D150
Immediate Lymphatic Reconstruction In The Prevention Of Breast Cancer Related Lymphedema: A Systematic Review And Meta-Analysis
Part of Topic
Outcomes
Background
•In breast cancer survivors, the development of breast-cancer related lymphedema (BCRL) is a common postoperative complication following Axillary Lymph Node Dissection (ALND)
•Reported incidence of 19.9%1
•Immediate Lymphatic Reconstruction (ILR) is a novel technique where lymphovenous bypass is done at the time of breast cancer surgery to prevent the development of BCRL
•Boccardo et al. (2009)2: Lymphatic Microsurgical Preventive Healing Approach (LYMPHA)
•While this technique is gaining traction and early results are promising, there has yet to be a wide-scale meta-analysis done that quantifies the treatment effect of ILR during ALND for the development of lymphedema
Objective
Conduct a systematic review and meta-analysis to examine the efficacy of ILR in preventing BCRL compared to those undergoing ALND without ILR.
Methods
•A review of Pubmed, Embase, and Scopus was performed for studies where ILR was performed at the time of breast cancer surgery
•Search terms: ((lymphedema) AND (prevention) AND (surgery) AND ((breast cancer))
•Exclusion criteria: non-ILR interventions, papers not in English, nonhuman subjects, purely descriptive papers, sample size of <20 patients, and literature reviews, letters, commentaries, case studies, and abstracts. Studies containing overlapping patients were also excluded
•Both double and single-armed studies were included
•Treatment effects were calculated using risk ratios (for single-arm studies, the incidence of BCRL following ALND was taken from the literature1)
•A meta-analysis was performed using the inverse variance method and a random-effects model, and treatment effects were reported as log risk ratios with 95% confidence intervals
Results
•19 total studies (n=2682) were included in the meta-analysis3-21
•8 double-arm studies that compared patients undergoing ILR (n=442) to patients that did not receive ILR (n=1286)
•11 single-arm studies that only included ILR patients (n=954)
•Treatment effects were expressed as the log risk ratio (95% CI):
•Double-arm: -0.96 (-1.36, -0.55
•Single-arm: -0.83 (-1.15, -0.51)
•The test for subgroup differences revealed no significant difference between double- and single-arm studies (p=0.64),
•Overall pooled treatment effect: -0.88 (-1.13, -0.63)
•This corresponded to a risk ratio of 0.41 (0.32, 0.53)
Patients who received ILR were 0.41 times as likely to develop lymphedema compared to those who did not receive ILR at the time of breast cancer surgery.
Conclusion
Patients who received ILR were significantly less likely to develop BCRL compared to those who did not. ILR is an effective and promising procedure to prevent the development of lymphedema in breast cancer survivors undergoing ALND.
References
1.DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013 May;14(6):500-15. doi: 10.1016/S1470-2045(13)70076-7. Epub 2013 Mar 27. PMID: 23540561.
2.Boccardo, Francesco, et al. "Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy." Annals of surgical oncology 16 (2009): 703-708.
3.Boccardo, Francesco M., et al. "Surgical prevention of arm lymphedema after breast cancer treatment." Annals of surgical oncology 18 (2011): 2500-2505.
4.Chung, Jae-Ho, et al. "Assessing the preventive effect of immediate lymphatic reconstruction on the upper extremity lymphedema." Gland Surgery 12.3 (2023): 334.
5.Coriddi, Michelle, et al. "Efficacy of immediate lymphatic reconstruction to decrease incidence of breast cancer-related lymphedema: preliminary results of randomized controlled trial." Annals of Surgery 278.4 (2023): 630-637.
6.Haravu, Pranav N., et al. "Establishment and Feasibility of an Immediate Lymphatic Reconstruction Program in a Community Health System." Annals of Surgical Oncology 31.1 (2024): 672-680.
7.Herremans, Kelly M., et al. "Five-year breast surgeon experience in LYMPHA at time of ALND for treatment of clinical T1–4N1–3M0 breast cancer." Annals of surgical oncology 28.10 (2021): 5775-5787.
8.Le, Nicole K., et al. "Immediate lymphatic reconstruction in 77 consecutive breast cancer patients: 2-year follow-up." Journal of Reconstructive Microsurgery 40.04 (2024): 262-267.
9.Levy, Adam S., et al. "Lymphatic microsurgical preventive healing approach for the primary prevention of lymphedema: a 4-year follow-up." Plastic and reconstructive surgery 151.2 (2023): 413-420.
10.Ozmen, Tolga, et al. "Evaluation of Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) for the prevention of breast cancer-related lymphedema after axillary lymph node dissection using bioimpedance spectroscopy." European Journal of Surgical Oncology 48.8 (2022): 1713-1717.
11.Boccardo, Francesco, et al. "Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer‐related lymphedema: Over 4 years follow‐up." Microsurgery 34.6 (2014): 421-424.
12.Brahma, Bayu, et al. "Supermicrosurgery lymphaticovenous and lymphaticolymphatic anastomosis: Technical detail and short-term follow-up for immediate lymphatic reconstruction in breast cancer treatment-related lymphedema prevention." Journal of Vascular Surgery: Venous and Lymphatic Disorders (2024): 101863.
13.Cook, Julia A., et al. "Immediate lymphatic reconstruction after axillary lymphadenectomy: single-institution early experience." Annals of Surgical Oncology 28 (2021): 1381-1387.
14.Feldman, Sheldon, et al. "Single institution experience with lymphatic microsurgical preventive healing approach (LYMPHA) for the primary prevention of lymphedema." Annals of surgical oncology 22 (2015): 3296-3301.
15.Granoff, Melisa D., et al. "A 4-year institutional experience of immediate lymphatic reconstruction." Plastic and Reconstructive Surgery 152.5 (2023): 773e-778e.
16.Le, Nicole K., et al. "The learning curve: trends in the first 100 immediate lymphatic reconstructions performed at a single institution." Annals of Plastic Surgery 86.6S (2021): S495-S497.
17.Schwarz, Graham S., et al. "Axillary reverse mapping and lymphaticovenous bypass: Lymphedema prevention through enhanced lymphatic visualization and restoration of flow." Journal of Surgical Oncology 120.2 (2019): 160-167.
18.Shaffer, Kristina, et al. "Lymphedema prevention surgery: improved operating efficiency over time." Annals of Surgical Oncology 27 (2020): 4695-4701.
19.Spoer, Daisy L., et al. "Lymphovenous Coupler-Assisted Bypass for Immediate Lymphatic Reconstruction." Journal of Reconstructive Microsurgery 40.05 (2024): 334-347.
20.D'Arcy, J. Wainwright, et al. "The Impact of Obesity on Success of Immediate Lymphatic Reconstruction for Prevention of Breast Cancer–Related Lymphedema." Annals of Plastic Surgery 92.6S (2024): S437-S440.
21.Weinstein, Brielle, et al. "Reverse lymphatic mapping and immediate microsurgical lymphatic reconstruction reduces early risk of breast cancer–related lymphedema." Plastic and Reconstructive Surgery 149.5 (2022): 1061-1069.
22.Page, Matthew J., et al. "The PRISMA 2020 statement: an updated guideline for reporting systematic reviews." bmj 372 (2021).