Prevention Of Breast Cancer Related Lymphedema With Prophylactic Lymph Node Transfer: Preliminary Results Of A Prospective Study
Edward I. Chang, MD, Min-Jeong Cho, MD, Mediget Teshome, MD, Kelly K. Hunt, MD.
MD Anderson Cancer Center, Houston, TX, USA.
Purpose: Breast cancer patients undergoing multimodality treatment including an axillary node dissection (AND), chemotherapy, and radiotherapy are at extremely high risk for developing breast cancer related lymphedema (BCRL). While there are surgical options to treat BCRL, there is no cure, so prevention may represent the best option.Methods: Prospective cohort study of all breast cancer patients who have undergone multimodality treatment electing to have autologous DIEP breast reconstruction and prophylactic vascularized lymph node transfer (VLNT) from 2016-2020 were included.Results: Twenty-five consecutive breast cancer patients (mean age: 47.6 years; mean BMI: 30.8 kg/m2) were enrolled. Two patients were diabetic, six were morbidly obese, and six were prior smokers. All patients underwent AND and chemoradiation. An average of 21.7 nodes were removed (range: 8-44). There were no flap losses and no cases of donor site lymphedema. Four patients suffered from wound healing in the reconstructed breast, and two patients developed wound healing complications in the abdominal donor site. With an average follow-up of 30.3 months, one patient (4.0%) developed lymphedema of the arm. One patient passed away from recurrent metastatic disease 13 months following reconstruction but had not developed lymphedema prior to her passing. Conclusions: Patients who have undergone an AND and chemoradiation for breast cancer are at high risk for developing lymphedema. Patients undergoing autologous free flap reconstruction should consider a simultaneous lymph node transfer for prevention of lymphedema.
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