Trends in Immediate Lymphatic Reconstruction

Shahnur Ahmed; Aladdin H Hassanein; Mary E Lester; Joshua Manghelli; Carla Fisher; Folosade Imeokparia; Kandice Ludwig; Betty Fan

doi:10.7759/cureus.59194

Trends in Immediate Lymphatic Reconstruction

Cureus. 2024 Apr 28;16(4):e59194. doi: 10.7759/cureus.59194. eCollection 2024 Apr.

Authors

Shahnur Ahmed¹, Aladdin H Hassanein², Mary E Lester³, Joshua Manghelli¹, Carla Fisher⁴, Folosade Imeokparia¹, Kandice Ludwig¹, Betty Fan⁵

Affiliations

¹ Surgery, Indiana University, Indianapolis, USA.
² Plastic Surgery, Indiana University School of Medicine, Indianapolis, USA.
³ Plastic Surgery, Indiana University, Indianapolis, USA.
⁴ Surgical Oncology, Indiana University School of Medicine, Indianapolis, USA.
⁵ Breast Surgery, University of Chicago Medicine, Chicago, USA.

Abstract

Background and objective Immediate lymphatic reconstruction (ILR) is emerging as a useful adjunct after axillary lymph node dissection (ALND), leading to a decrease in lymphedema rates from 30 to 3-13% in breast cancer patients. ILR requires coordination between two surgical specialties for oncologic ALND and microsurgical axillary lymphatic anastomosis. This study aimed to assess the trends in the frequency of ILR performed after ALND at our institution. Methods This study involved a retrospective review of breast cancer patients undergoing ALND with and without ILR at our institution (2017-2022). Data on patient demographics, tumor characteristics, and treatments received were gathered and analyzed. Results A total of 316 patients underwent ALND at our institution and 30.7% (97/316) of them received ILR. There was no significant difference in clinical breast cancer stages between patients who underwent ALND with or without ILR (p>0.05). Neoadjuvant chemotherapy was given to 51.1% (112/219) of patients with ALND only compared to 60.8% (59/97) of patients who underwent ALND with ILR (p=0.09). All patients received adjuvant radiation therapy. ILR was performed after ALND in 4.2% (2/47) in 2017, 25.8% (3/58) in 2018, 17.6% (12/68) in 2019, 35% (21/60) in 2020, 56.9% (41/72) in 2021, and 54.5% (6/11) in 2022. When comparing the first year of the ILR program with the last year of the study period, the odds ratio of receiving ILR after ALND was 1.8 (p=0.04). Conclusions The frequency of performing ILR after ALND in breast cancer patients at our institution witnessed a substantial increase during the study period. The implementation of an established ILR program at an institution can increase procedure uptake accompanied by continued growth in utilization.

Keywords: alnd: - axillary lymph node dissection; axillary lymphadenectomy; breast cancer related lymphedema; breast lymphedema; lympho-venous-anastomosis.