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Immediate Lymphatic Reconstruction Reduces Volume Difference And Improves Functional Outcomes In Patients At Risk For Lymphedema: Follow Up Assessment Of A Prospective Database
Ricardo Engel, MD, Zofia Caes, BA, Maureen Beederman, MD, David Chang, MD, Summer E. Hanson, MD, PhD.
The University of Chicago, Chicago, IL, USA.
PURPOSE: Patients undergoing axillary node dissection are at highest risk for developing lymphedema; however, the role of immediate lymphatic reconstruction (ILR) for prevention is not completely defined. The purpose of this study was to obtain follow up assessments of patients who underwent ALND with or without ILR.
METHODS: Patients who were previously enrolled in our prospective ILR database between 2018 and 2022 were contacted for follow up. The primary outcome measure was lymphedema based on volume difference of the arms. Additional measures included bioimpedance spectroscopy (BIS), circumference, and patient surveys (LLIS, ASES, DASH).
RESULTS: 71 patients were screened and 34 agreed to participate. The mean follow-up time was 4.29 years. Average age was 52 (27-72) years with BMI 28.3 (21.6-35.7). All patients had axillary lymph node dissection followed by post-operative radiation therapy. There was a significant difference in the volume differential between the affected and unaffected arms of those who underwent ILR compared to those who did not (5.6% vs 12.4%; p=0.017). Upper extremity functional scores (ASES) were statistically and clinically significant, favoring those who underwent ILR (90.2 vs 83.3; p=0.001). There was a trend to lower L-Dex values in the ILR group compared to no ILR though this did not achieve statistical significance (6.1 vs 14.7; p= 0.08).
CONCLUSION: The authors demonstrate statistically significant and clinically meaningful outcomes in patients who underwent immediate lymphatic reconstruction with more than 4 years follow up. Further prospective and randomized studies are warranted to clearly define the role of ILR in high-risk patients.
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