Brown Stav, Shen Yizhuo, Klimitz Felix J, Nair Meera, Mattia Alexzandra, Kauke-Navarro Martin, Noel Olivier F, Wo Luccie, Pomahac Bohdan, Lofti Parisa, Golshan Mehra, Haykal Siba
Plastic and Reconstructive Surgery Division, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Radiology and Biomedical Imaging Department, Yale School of Medicine, New Haven, CT, USA.
Ann Surg Oncol. 2025 Sep 17. doi: 10.1245/s10434-025-18333-2.
Despite the growing use of immediate lymphatic reconstruction (ILR) for preventing lymphedema, prospective long-term data on its efficacy remain limited.
This study aimed to analyze long-term, prospective outcomes of ILR, utilizing all available outcome measures.
Outcome data included the pooled cumulative incidence of lymphedema (assessed by limb measurements), odds ratio (OR), and relative risk (RR) for lymphedema development in patients who underwent ILR versus those who did not. Only prospective clinical trials with a minimum of 12 months of follow-up were included.
Nine prospective studies (2011-2024) were included, totaling 791 patients, with 460 undergoing ILR and an average follow-up of 20.6 ± 4.8 months. On average, 1.9 ± 0.4 anastomoses were performed per patient. ILR was associated with a significantly lower incidence of lymphedema: 9% (95% confidence interval [CI] 1-16%) compared with 29% (95% CI 11-46%) in the non-ILR group. Patients who received ILR had 69% lower odds of developing lymphedema compared with those without ILR (OR 0.31, 95% CI 0.19-0.51). A 58% reduction in lymphedema risk was also observed among ILR recipients (RR 0.42, 95% CI 0.26-0.68).
This meta-analysis summarizing prospective data with a minimum of 12-month follow-up represents the largest evaluation to date of ILR with extended follow-up for lymphedema prevention. The findings demonstrate that ILR significantly reduces the incidence, odds, and risk of lymphedema, supporting its role as an effective preventive strategy in at-risk patients.
尽管即时淋巴重建术（ILR）在预防淋巴水肿方面的应用日益广泛，但其疗效的前瞻性长期数据仍然有限。
本研究旨在利用所有可用的结局指标，分析ILR的长期前瞻性结局。
结局数据包括淋巴水肿的汇总累积发病率（通过肢体测量评估）、接受ILR患者与未接受ILR患者发生淋巴水肿的比值比（OR）和相对风险（RR）。仅纳入随访时间至少为12个月的前瞻性临床试验。
纳入9项前瞻性研究（2011 - 2024年），共791例患者，其中460例接受了ILR，平均随访时间为20.6 ± 4.8个月。每位患者平均进行1.9 ± 0.4次吻合。ILR与淋巴水肿的发生率显著降低相关：为9%（95%置信区间[CI] 1 - 16%），而非ILR组为29%（95% CI 11 - 46%）。与未接受ILR的患者相比，接受ILR的患者发生淋巴水肿的几率低69%（OR 0.31，95% CI 0.19 - 0.51）。在接受ILR者中还观察到淋巴水肿风险降低了58%（RR 0.42，95% CI 0.26 - 0.68）。
这项汇总了至少12个月随访的前瞻性数据的荟萃分析，是迄今为止对ILR预防淋巴水肿进行长期随访的最大规模评估。研究结果表明，ILR显著降低了淋巴水肿的发生率、几率和风险，支持其作为高危患者有效预防策略的作用。
