Division of Breast Surgery, Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA.
Breast Cancer Res Treat. 2022 Dec;196(3):657-664. doi: 10.1007/s10549-022-06758-2. Epub 2022 Oct 14.
Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) can reduce the incidence of lymphedema in patients with breast cancer. The oncologic safety of ILR is unknown and has not been reported. The purpose of this study was to evaluate if ILR is associated with increased breast cancer recurrence rates.
Patients with breast cancer who underwent ALND with ILR from September 2016 to December 2020 were identified from a prospective institutional database. Patient demographics, tumor characteristics, and operative details were recorded. Follow-up included the development of local recurrence as well as distant metastasis. Oncologic outcomes were analyzed.
A total of 137 patients underwent ALND with ILR. At cancer presentation, 122 patients (89%) had clinically node positive primary breast cancer, 10 patients (7.3%) had recurrent breast cancer involving the axillary lymph nodes, 3 patients (2.2%) had recurrent breast cancer involving both the breast and axillary nodes, and 2 patients (1.5%) presented with axillary disease/occult breast cancer. For surgical management, 103 patients (75.2%) underwent a mastectomy, 22 patients (16%) underwent lumpectomy and 12 patients (8.8%) had axillary surgery only. The ALND procedure, yielded a median of 15 lymph nodes pathologically identified (range 3-41). At a median follow-up of 32.9 months (range 6-63 months), 17 patients (12.4%) developed a local (n = 1) or distant recurrence (n = 16), however, no axillary recurrences were identified.
Immediate lymphatic reconstruction in patients with breast cancer undergoing ALND is not associated with short term axillary recurrence and appears oncologically safe.
在腋窝淋巴结清扫术 (ALND) 时进行即时淋巴重建 (ILR) 可以降低乳腺癌患者发生淋巴水肿的发生率。ILR 的肿瘤安全性尚不清楚，也尚未有报道。本研究旨在评估 ILR 是否与乳腺癌复发率增加有关。
从一个前瞻性的机构数据库中确定了 2016 年 9 月至 2020 年 12 月期间接受 ALND 联合 ILR 的乳腺癌患者。记录患者的人口统计学特征、肿瘤特征和手术细节。随访包括局部复发和远处转移的发生。分析肿瘤学结果。
共 137 例患者接受了 ALND 联合 ILR。在癌症初诊时，122 例（89%）患者的原发性乳腺癌临床淋巴结阳性，10 例（7.3%）患者的复发性乳腺癌累及腋窝淋巴结，3 例（2.2%）患者的复发性乳腺癌累及乳房和腋窝淋巴结，2 例（1.5%）患者的表现为腋窝疾病/隐匿性乳腺癌。在手术管理方面，103 例（75.2%）患者接受了乳房切除术，22 例（16%）患者接受了保乳手术，12 例（8.8%）患者仅接受了腋窝手术。ALND 手术中，平均获得 15 个病理淋巴结（范围 3-41 个）。在中位随访 32.9 个月（范围 6-63 个月）时，17 例（12.4%）患者出现局部（n=1）或远处复发（n=16），但未发现腋窝复发。
在接受 ALND 的乳腺癌患者中进行即时淋巴重建与短期腋窝复发无关，且在肿瘤学上是安全的。
