From the Division of Plastic and Reconstructive Surgery.
Department of Surgery.
Plast Reconstr Surg. 2023 Nov 1;152(5):773e-778e. doi: 10.1097/PRS.0000000000010381. Epub 2023 Mar 8.
Up to one in three patients may go on to develop breast cancer-related lymphedema (BCRL) after treatment. Immediate lymphatic reconstruction (ILR) has been shown in early studies to reduce the risk of BCRL, but long-term outcomes are limited because of its recent introduction and institutions' differing eligibility requirements. This study evaluated the incidence of BCRL in a cohort that underwent ILR over the long term.
A retrospective review of all patients referred for ILR at the authors' institution from September of 2016 through September of 2020 was performed. Patients with preoperative measurements, a minimum of 6 months of follow-up data, and at least one completed lymphovenous bypass were identified. Medical records were reviewed for demographics, cancer treatment data, intraoperative management, and lymphedema incidence.
A total of 186 patients with unilateral node-positive breast cancer underwent axillary nodal surgery and an attempt at ILR over the study period. Ninety patients underwent successful ILR and met all eligibility criteria, with a mean patient age of 54 ± 12.1 years and median body mass index of 26.6 kg/m 2 [interquartile range (IQR), 24.0 to 30.7 kg/m 2 ]. The median number of lymph nodes removed was 14 (IQR, eight to 19). Median follow-up was 17 months (range, 6 to 49 months). Eighty-seven percent of patients underwent adjuvant radiotherapy, and among them, 97% received regional lymph node irradiation. The overall rate of lymphedema was 9% at the end of the study period.
With the use of strict follow-up guidelines over the long term, the authors' findings support that ILR at the time of axillary lymph node dissection is an effective procedure that reduces the risk of BCRL in a high-risk patient population.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
多达三分之一的患者在治疗后可能会发展为乳腺癌相关淋巴水肿（BCRL）。早期研究表明，即刻淋巴重建（ILR）可降低 BCRL 的风险，但由于其最近引入以及机构不同的资格要求，长期结果有限。本研究评估了在长期接受 ILR 的患者队列中 BCRL 的发生率。
对作者所在机构 2016 年 9 月至 2020 年 9 月间所有接受 ILR 治疗的患者进行了回顾性分析。确定了有术前测量值、至少 6 个月随访数据和至少一次完成淋巴静脉旁路的患者。回顾了病历以获取人口统计学、癌症治疗数据、术中管理和淋巴水肿发生率。
在研究期间，共有 186 例单侧淋巴结阳性乳腺癌患者接受了腋窝淋巴结手术和 ILR 尝试。90 例成功进行了 ILR 并符合所有入选标准，患者平均年龄为 54 ± 12.1 岁，中位体重指数为 26.6 kg/m 2 [四分位距（IQR），24.0 至 30.7 kg/m 2 ]。切除的淋巴结中位数为 14 个（IQR，8 至 19 个）。中位随访时间为 17 个月（范围，6 至 49 个月）。87%的患者接受了辅助放疗，其中 97%接受了区域淋巴结照射。研究结束时，总的淋巴水肿发生率为 9%。
通过长期使用严格的随访指南，作者的研究结果支持在腋窝淋巴结清扫术时进行 ILR 是一种有效的方法，可以降低高危患者人群中 BCRL 的风险。
临床问题/证据水平：治疗性，IV。
