Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
J Reconstr Microsurg. 2022 Oct;38(8):613-620. doi: 10.1055/s-0042-1742730. Epub 2022 Feb 14.
Breast cancer treatment, including axillary lymph node excision, radiation, and chemotherapy, can cause upper extremity lymphedema, increasing morbidity and health care costs. Institutions increasingly perform prophylactic lymphovenous bypass (LVB) at the time of axillary lymph node dissection (ALND) to reduce the risk of lymphedema but reports of complications are lacking. We examine records from the American College of Surgeons (ACS) National Surgery Quality Improvement Program (NSQIP) database to examine the safety of these procedures.
Procedures involving ALND from 2013 to 2019 were extracted from the NSQIP database. Patients who simultaneously underwent procedures with the Current Procedural Terminology (CPT) codes 38999 (other procedures of the lymphatic system), 35201 (repair of blood vessel), or 38308 (lymphangiotomy) formed the prophylactic LVB group. Patients in the LVB and non-LVB groups were compared for differences in demographics and 30-day postoperative complications including unplanned reoperation, deep vein thrombosis (DVT), wound dehiscence, and surgical site infection. Subgroup analysis was performed, controlling for extent of breast surgery and reconstruction. Multivariate logistic regression was performed to identify predictors of reoperation.
The ALND without LVB group contained 45,057 patients, and the ALND with LVB group contained 255 (0.6%). Overall, the LVB group was associated with increased operative time (288 vs. 147 minutes, < 0.001) and length of stay (1.7 vs. 1.3 days, < 0.001). In patients with concurrent mastectomy without immediate reconstruction, the LVB group had a higher rate of DVTs (3.0 vs. 0.2%, = 0.009). Reoperation, wound infection, and dehiscence rates did not differ across subgroups. Multivariate logistic regression showed that LVB was not a predictor of reoperations.
Prophylactic LVB at time of ALND is a generally safe and well-tolerated procedure and is not associated with increased reoperations or wound complications. Although only four patients in the LVB group had DVTs, this was a significantly higher rate than in the non-LVB group and warrants further investigation.
乳腺癌的治疗包括腋窝淋巴结切除、放疗和化疗，这些治疗可能导致上肢淋巴水肿，增加发病率和医疗保健成本。各机构越来越多地在腋窝淋巴结清扫术 (ALND) 时进行预防性淋巴静脉旁路术 (LVB)，以降低淋巴水肿的风险，但缺乏相关并发症的报告。我们通过美国外科医师学院 (ACS) 国家手术质量改进计划 (NSQIP) 数据库的记录来检查这些手术的安全性。
从 NSQIP 数据库中提取 2013 年至 2019 年期间进行的 ALND 手术。同时进行了当前程序术语 (CPT) 代码 38999（淋巴系统的其他程序）、35201（血管修复）或 38308（淋巴管切开术）的患者被归入预防性 LVB 组。比较了 LVB 组和非 LVB 组之间的人口统计学差异和 30 天术后并发症，包括非计划再次手术、深静脉血栓形成 (DVT)、伤口裂开和手术部位感染。进行了亚组分析，控制了乳房手术和重建的范围。采用多变量逻辑回归来确定再次手术的预测因素。
无 LVB 的 ALND 组包含 45057 名患者，而有 LVB 的 ALND 组包含 255 名（0.6%）患者。总体而言，LVB 组的手术时间（288 分钟 vs. 147 分钟， < 0.001）和住院时间（1.7 天 vs. 1.3 天， < 0.001）更长。在同时进行乳房切除术但无即刻重建的患者中，LVB 组的 DVT 发生率更高（3.0% vs. 0.2%， = 0.009）。在各亚组中，再次手术、伤口感染和裂开的发生率没有差异。多变量逻辑回归显示，LVB 不是再次手术的预测因素。
ALND 时进行预防性 LVB 通常是一种安全且耐受良好的手术，与增加的再次手术或伤口并发症无关。尽管 LVB 组中只有 4 例患者发生了 DVT，但这一比率明显高于非 LVB 组，值得进一步研究。
