Establishment and Feasibility of an Immediate Lymphatic Reconstruction Program in a Community Health System

• Published in: Annals of surgical oncology 2024, Vol.31 (1), p.672-680
• Main Authors: Haravu, Pranav N., Shakir, Afaaf, Jackson, Katherine, Alva, Duanny, Feldman, Joseph, Sisco, Mark, Seth, Akhil K.
• Format: Article
• Language: English
• Subjects: Arm; Axilla - pathology; Body mass index; Breast cancer; Breast Cancer Lymphedema - etiology; Breast Neoplasms - pathology; Cancer therapies; Community Health Planning; Electronic medical records; Feasibility Studies; Female; Humans; Lymph Node Excision - adverse effects; Lymph nodes; Lymphedema; Lymphedema - etiology; Lymphedema - pathology; Lymphedema - prevention & control; Medicine; Medicine & Public Health; Oncology; Patients; Reconstructive Oncology; Retrospective Studies; Sentinel Lymph Node Biopsy - adverse effects; Surgery; Surgical Oncology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-023-14521-0

Background Breast cancer-related lymphedema (BCRL) remains a significant post-surgical complication of breast cancer treatment. Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) has shown promise in preventing BCRL. While the primary literature supporting ILR comes from academic institutions, the majority of breast cancer care in the USA occurs in the community setting. This study evaluated a preventative lymphedema program performing ILR at a community health system. Patients and Methods A prospective database including all patients who underwent ALND with concurrently attempted ILR from 2019 to 2021 was retrospectively reviewed. The historical benchmark lymphedema rate was calculated through retrospective review of electronic medical records for all patients who underwent ALND without ILR from 2011 to 2021. Results Ninety patients underwent ALND with ILR, of which ILR was successful in 69 (76.7%). ILR was more likely to be aborted in smokers ( p < 0.05) and those with fewer lymphatic channels ( p < 0.05) or a higher body mass index (BMI) ( p = 0.08). Patients with successful versus aborted ILR had lower lymphedema rates (10.9% versus 66.7%, p < 0.01) and improved Disability of the Arm, Shoulder, and Hand (DASH) scores (8.7 versus 19.8, p = 0.25), and lower lymphedema rates than the historical benchmark (10.9% versus 50.2%, p < 0.01). Among patients with successful ILR, older patients were more likely to develop lymphedema ( p < 0.05). Conclusions Successful ILR after ALND significantly reduced the lymphedema rate when compared with patients with aborted ILR and our institution’s historical benchmark. Our experience supports the efficacy of ILR and highlights the feasibility of ILR within a community health system.