Hill W K Fraser, Deban Melina, Platt Alexander, Rojas-Garcia Priscilla, Jost Evan, Temple-Oberle Claire
Section of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Section of Surgical Oncology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Plast Reconstr Surg Glob Open. 2022 May 9;10(5):e4291. doi: 10.1097/GOX.0000000000004291. eCollection 2022 May.
The objective of this study is to summarize the current body of evidence detailing the impact of immediate lymphatic reconstruction (ILR) on the incidence of breast cancer-related lymphedema (BCRL) following axillary node dissection (ALND).
Medline and Embase databases were queried for publications, where ILR was performed at the time of ALND for breast cancer. Exclusion criteria included lymphaticovenous anastomosis for established BCRL, animal studies, non-breast cancer patient population studies, and descriptive studies detailing surgical technique. Meta-analysis was performed with a forest plot generated using a Mantel -Haenszel statistical method, with a random-effect analysis model. Effect measure was reported as risk ratios with associated 95% confidence intervals. The risk of bias within studies was assessed by the Cochrane Collaboration tool.
This systematic review yielded data from 11 studies and 417 breast cancer patients who underwent ILR surgery at the time of ALND. There were 24 of 417 (5.7%) patients who developed BCRL following ILR. Meta-analysis revealed that in the ILR group, 6 of 90 patients (6.7%) developed lymphedema, whereas in the control group, 17 of 50 patients (34%) developed lymphedema. Patients in the ILR group had a risk ratio of 0.22 (CI, 0.09 -0.52) of lymphedema with a number needed to treat of four.
There is a clear signal indicating the benefit of ILR in preventing BCRL. Randomized control trials are underway to validate these findings. ILR may prove to be a beneficial intervention for improving the quality of life of breast cancer survivors.
本研究的目的是总结当前详细阐述即时淋巴重建（ILR）对腋窝淋巴结清扫术（ALND）后乳腺癌相关淋巴水肿（BCRL）发生率影响的证据。
查询Medline和Embase数据库中关于在乳腺癌ALND时进行ILR的出版物。排除标准包括针对已确诊BCRL的淋巴管静脉吻合术、动物研究、非乳腺癌患者群体研究以及详细描述手术技术的描述性研究。采用Mantel - Haenszel统计方法生成森林图进行荟萃分析，采用随机效应分析模型。效应量报告为风险比及相关的95%置信区间。通过Cochrane协作工具评估研究中的偏倚风险。
该系统评价纳入了11项研究中的数据以及417例在ALND时接受ILR手术的乳腺癌患者。417例患者中有24例（5.7%）在ILR后发生BCRL。荟萃分析显示，ILR组90例患者中有6例（6.7%）发生淋巴水肿，而对照组50例患者中有17例（34%）发生淋巴水肿。ILR组患者发生淋巴水肿的风险比为0.22（CI，0.09 - 0.52），需治疗人数为4。
有明确迹象表明ILR在预防BCRL方面有益。正在进行随机对照试验以验证这些发现。ILR可能被证明是一种改善乳腺癌幸存者生活质量的有益干预措施。
