Immediate lymphatic reconstruction with targeted lymphatic axillary repair

Abstract

Current surgical treatment for established lymphedema can be challenging and not always successful. To reduce the incidence of post-operative lymphedema, we began trialing targeted lymphatic axillary repair (TLAR) as a technique for immediate lymphatic reconstruction with the aim of reducing post-operative lymphedema incidence. In this observational prospective study, conducted between March 2017 and May 2022, we assessed the effectiveness of TLAR in reducing lymphedema occurrence in consecutive breast cancer patients who underwent surgery involving axillary lymph node dissection (ALND). Patients meeting the inclusion criteria were considered for simultaneous lymphedema risk-reducing surgery using TLAR. They were monitored for a minimum of 18 months by medical physiotherapists, and post-operative testing was conducted using indocyanine green lymphography. Among the 50 women who underwent TLAR, 34 (68%) received neoadjuvant chemotherapy. On an average, 2.18 lymphatics were identified per patient, with a mean of 1.84 lymphatico-venous anastomoses performed. Adjuvant axillary radiotherapy was administered to 41 patients (82%), with axillary levels I-II spared from direct radiotherapy in 24 patients (48%). Only 2 patients (4%) developed lymphedema during the minimum 18.2-month follow-up period. In conclusion, TLAR is shown to be a safe, effective, and physiologic technique for reducing lymphedema risk in patients with breast cancer.