Efficacy of immediate lymphatic reconstruction to decrease incidence of breast cancer-related lymphedema: Preliminary results of randomized controlled trial Conference Paper
| Authors: | Coriddi, M.; Dayan, J.; Bloomfield, E.; McGrath, L.; Diwan, R.; Monge, J.; Gutierrez, J.; Brown, S.; Boe, L.; Mehrara, B. |
| Title: | Efficacy of immediate lymphatic reconstruction to decrease incidence of breast cancer-related lymphedema: Preliminary results of randomized controlled trial |
| Conference Title: | 143rd Annual Meeting of the American Surgical Association (ASA) |
| Abstract: | Objective: To conduct a randomized controlled trial (RCT) on the efficacy of immediate lymphatic reconstruction (ILR) for decreasing the incidence of breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND). Background: Despite encouraging results in small studies, an appropriately powered RCT on ILR has not been performed. Methods: Women undergoing ALND for breast cancer were randomized in the operating room 1:1 to either ILR, if technically feasible, or no ILR (control). The ILR group underwent lymphatic anastomosis to a regional vein using microsurgical techniques; control group had no repair and cut lymphatics were ligated. Relative volume change (RVC), bioimpedance, quality of life (QoL), and compression use were evaluated at baseline and every 6 months postoperatively up to 24 months. Indocyanine green (ICG) lymphography was performed at baseline and 12 and 24 months postoperatively. The primary outcome was the incidence of BCRL, defined as ≥10% RVC from baseline in the affected extremity at 12-, 18-, or 24-month follow-up. Results: Of 72 patients randomized to ILR and 72 to control from January 2020 to March 2023, our preliminary analysis includes 99 patients with 12-month follow-up, 70 with 18-month follow-up, and 40 with 24-month follow-up. The cumulative incidence of BCRL was 9.5% in the ILR group and 32% in the control group (P=0.014). The ILR group had lower bioimpedance values, decreased compression usage, better lymphatic function on ICG lymphography, and better QoL than the control group. Conclusions: Preliminary results of our RCT show that ILR after ALND decreases BCRL incidence. Our goal is to finish the accrual of 174 patients with 24-month follow-up. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. |
| Keywords: | controlled study; lymph node dissection; lymph node excision; breast cancer; randomized controlled trial; incidence; pathology; breast neoplasms; lymphedema; breast tumor; surgery; axilla; indocyanine green; humans; human; female; breast cancer-related lymphedema; breast cancer lymphedema; immediate lymphatic reconstruction |
| Journal Title | Annals of Surgery |
| Volume: | 278 |
| Issue: | 4 |
| Conference Dates: | 2023 Apr 20-22 |
| Conference Location: | Toronto, Canada |
| ISBN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2023-10-01 |
| Start Page: | 630 |
| End Page: | 637 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000005952 |
| PUBMED: | 37314177 |
| PROVIDER: | scopus |
| PMCID: | PMC10527595 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Michelle Coriddi -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work