He Zhiting, Zhang Lijuan, Huang Shanshan, Xie Yi, Qiu Yu, Wu Linyu, Xie Xinhua
State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.
Gland Surg. 2025 Aug 31;14(8):1539-1548. doi: 10.21037/gs-2025-40. Epub 2025 Aug 26.
The most common chronic complication following breast cancer surgery is breast cancer-related lymphedema (BCRL). Lymphovenous anastomosis (LVA) is a surgical treatment for lymphedema, but it could not cure lymphedema. Immediate lymphatic reconstruction (ILR) has been shown in early studies to reduce the risk of BCRL. The objective of this study is to detail the impact of ILR on the incidence of BCRL and to summarize the current opportunities and challenges of ILR.
We performed a systematic review through September 2024 of the Web of Science, Embase, and PubMed databases. There were cohort studies that documented the incidence of BCRL having undergone ILR. BCRL occurrences between the ILR and no ILR group were compared using a comparative meta-analysis of five studies. Additionally, a single percentage meta-analysis was conducted using 12 papers that documented the events of BCRL after ILR.
The 12 papers included all met the criteria for analysis. The incidence of BCRL in the no ILR group was higher than that in the ILR group, according to a comparative meta-analysis, and there was a statistically significant difference [odds ratio (OR): 0.14; 95% confidence interval (CI): 0.08-0.24; P<0.001]. Besides, the incidence of BCRL of the IRL group was 8.6% (95% CI: 6-12%), according to a meta-analysis of single percentages. The results of the subgroup analysis showed that follow-up time of less than 1 year or more than 1 year after ILR was not significantly associated with the incidence of BCRL (P=0.40).
There is a definite indication that ILR is beneficial in preventing BCRL. This might be a helpful intervention for improving the quality of life of breast cancer survivors.
乳腺癌手术后最常见的慢性并发症是乳腺癌相关淋巴水肿（BCRL）。淋巴静脉吻合术（LVA）是一种治疗淋巴水肿的手术方法，但无法治愈淋巴水肿。早期研究表明，即时淋巴重建（ILR）可降低BCRL的风险。本研究的目的是详细阐述ILR对BCRL发生率的影响，并总结ILR目前面临的机遇和挑战。
我们对截至2024年9月的Web of Science、Embase和PubMed数据库进行了系统综述。纳入了记录接受ILR治疗后BCRL发生率的队列研究。通过对五项研究的比较荟萃分析，比较了ILR组和非ILR组之间BCRL的发生情况。此外，使用12篇记录ILR后BCRL事件的论文进行了单一百分比荟萃分析。
纳入的12篇论文均符合分析标准。根据比较荟萃分析，非ILR组的BCRL发生率高于ILR组，差异具有统计学意义[优势比（OR）：0.14；95%置信区间（CI）：0.08 - 0.24；P<0.001]。此外，根据单一百分比荟萃分析，ILR组的BCRL发生率为8.6%（95%CI：6 - 12%）。亚组分析结果显示，ILR后随访时间少于1年或超过1年与BCRL发生率无显著相关性（P = 0.40）。
有明确迹象表明ILR有助于预防BCRL。这可能是一种有助于改善乳腺癌幸存者生活质量的干预措施。
