Division of Surgical Oncology, Mayo Clinic, Jacksonville, FL, USA.
Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2024 Oct;31(11):7349-7359. doi: 10.1245/s10434-024-15715-w. Epub 2024 Jul 2.
Immediate lymphatic reconstruction (ILR) has been proposed to decrease lymphedema rates. The primary aim of our study was to determine whether ILR decreased the incidence of lymphedema in patients undergoing axillary lymph node dissection (ALND).
We conducted a two-site pragmatic study of ALND with or without ILR, employing surgeon-level cohort assignment, based on breast surgeons' preferred standard practice. Lymphedema was assessed by limb volume measurements, patient self-reporting, provider documentation, and International Classification of Diseases, Tenth Revision (ICD-10) codes.
Overall, 230 patients with breast cancer were enrolled; on an intention-to-treat basis, 99 underwent ALND and 131 underwent ALND with ILR. Of the 131 patients preoperatively planned for ILR, 115 (87.8%) underwent ILR; 72 (62.6%) were performed by one breast surgical oncologist and 43 (37.4%) by fellowship-trained microvascular plastic surgeons. ILR was associated with an increased risk of lymphedema when defined as ≥10% limb volume change on univariable analysis, but not on multivariable analysis, after propensity score adjustment. We did not find a statistically significant difference in limb volume measurements between the two cohorts when including subclinical lymphedema (≥5% inter-limb volume change), nor did we see a difference in grade between the two cohorts on an intent-to-treat or treatment received basis. For all patients, considering ascertainment strategies of patient self-reporting, provider documentation, and ICD-10 codes, as a single binary outcome measure, there was no significant difference in lymphedema rates between those undergoing ILR or not.
We found no significant difference in lymphedema rates between patients undergoing ALND with or without ILR.
即刻淋巴重建（ILR）被提议用于降低淋巴水肿的发生率。我们研究的主要目的是确定 ILR 是否降低接受腋窝淋巴结清扫术（ALND）的患者的淋巴水肿发生率。
我们进行了一项基于乳腺外科医生首选标准实践的二站点实用研究，对接受或不接受 ILR 的 ALND 进行了外科医生级别的队列分配。淋巴水肿通过肢体体积测量、患者自我报告、提供者记录和国际疾病分类第 10 版（ICD-10）代码进行评估。
共有 230 名乳腺癌患者入组；基于意向治疗原则，99 名患者接受了 ALND，131 名患者接受了 ALND 加 ILR。在术前计划接受 ILR 的 131 名患者中，115 名（87.8%）接受了 ILR；72 名（62.6%）由一名乳腺外科肿瘤学家进行，43 名（37.4%）由接受过 fellowship培训的显微血管整形外科医生进行。单变量分析时，ILR 与淋巴水肿风险增加相关，但多变量分析调整倾向评分后无统计学意义。当包括亚临床淋巴水肿（肢体体积变化≥5%）时，两组之间的肢体体积测量值没有统计学差异，也没有看到两组之间在意向治疗或接受治疗的基础上存在差异。对于所有患者，考虑患者自我报告、提供者记录和 ICD-10 代码的确定策略，作为单一的二分类结局指标，接受或不接受 ILR 的患者的淋巴水肿发生率没有显著差异。
我们没有发现接受或不接受 ILR 的 ALND 患者的淋巴水肿发生率有显著差异。
