Aschen Seth Z, Zhang Ashley, Diwan Richard, Dinh Dinh-Do, Giles Caitlin, Bloomfield Emily, Yoshimatsu Hidehiko, Mehrara Babak J, Coriddi Michelle
Plastic & Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, USA.
Columbia University Vagelos College of Physicians and Surgeons, NY, NY, USA.
JPRAS Open. 2025 Apr 4;44:448-462. doi: 10.1016/j.jpra.2025.03.021. eCollection 2025 Jun.
Breast cancer related lymphedema (BCRL) is a complication of breast cancer treatment, affecting 10-56% of women who undergo axillary lymph node dissection. Immediate lymphatic reconstruction (ILR) is an emerging intervention to reduce the risk of lymphedema development at the time of axillary lymph node dissection. This study assesses the current body of evidence on ILR, with specific focus on efficacy in preventing breast cancer-related lymphedema, operative technique, and its safety profile. PubMed, Embase, and Cochrane databases were queried for studies on ILR published up to September 30, 2024. Studies involving lymphatic reconstruction after the development of BCRL were excluded. The systematic review identified 18 studies, 16 focusing on BCRL development and 2 focusing on oncologic recurrence outcomes. Of 785 patients receiving ILR, the cumulative BCRL rate was 13.3% with a median follow-up time of 15 months. Of 696 control group patients, the cumulative BCRL rate was 26.1% at a median follow-up time of 14.6 months. BCRL rates were higher in both groups in studies with longer follow-up times. This systematic review revealed an overall relative risk (RR) of 0.51 of developing BCRL in patients receiving ILR after axillary lymph node dissection. The RR was 0.33 in studies with a follow-up duration of fewer than 18 months and 0.60 in those with longer follow-up periods. Newer studies have included longer follow-up times and the inclusion of control groups, allowing for better evaluation of the long-term efficacy of ILR. This study also highlighted areas of focus for future study, including standardization of technique and lymphedema diagnosis, oncologic safety, and patient-reported outcomes.
乳腺癌相关淋巴水肿（BCRL）是乳腺癌治疗的一种并发症，影响10%-56%接受腋窝淋巴结清扫术的女性。即时淋巴重建（ILR）是一种新兴的干预措施，可降低腋窝淋巴结清扫术时淋巴水肿发生的风险。本研究评估了关于ILR的现有证据，特别关注其预防乳腺癌相关淋巴水肿的疗效、手术技术及其安全性。通过检索PubMed、Embase和Cochrane数据库，查找截至2024年9月30日发表的关于ILR的研究。排除涉及BCRL发生后进行淋巴重建的研究。系统评价确定了18项研究，其中16项关注BCRL的发生，2项关注肿瘤复发结局。在785例接受ILR的患者中，BCRL累积发生率为13.3%，中位随访时间为15个月。在696例对照组患者中，BCRL累积发生率为26.1%，中位随访时间为14.6个月。在随访时间较长的研究中，两组的BCRL发生率均较高。该系统评价显示，腋窝淋巴结清扫术后接受ILR的患者发生BCRL的总体相对风险（RR）为0.51。在随访时间少于18个月的研究中，RR为0.33，在随访时间较长的研究中，RR为0.60。较新的研究纳入了更长的随访时间并设立了对照组，从而能够更好地评估ILR的长期疗效。本研究还强调了未来研究的重点领域，包括技术和淋巴水肿诊断的标准化、肿瘤学安全性以及患者报告的结局。
