The effect of immediate lymphatic reconstruction on the post-operative drain output after axillary lymph node dissection for breast cancer: A retrospective comparative study

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2023-02-10 DOI:10.1002/micr.31007

Ying-Sheng Lin MD, MPH, Chen-Hsiang Kuan MD, PhD, Li-Wei Tsai MD, Chien-Hui Wu MD, Chieh-Huei Huang MD, Eng-Kean Yeong MD, Hao-Chih Tai MD, PhD, Chiun-Sheng Huang MD, PhD

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Abstract

Introduction

Axillary lymph node dissection (ALND) for breast cancer has been considered to be associated with a variety of complications, such as excessive postoperative wound drainage, prolonged drain placement, or seroma formation in the short term, or arm lymphedema in the long run. Immediate lymphedema reconstruction (ILR) has been proposed to reduce the occurrence of arm lymphedema by anastomosing the transected arm lymphatics to nearby branches of the axillary vein immediately after ALND. This study aims to demonstrate that ILR can also reduce the postoperative drainage amount.

Patients and Methods

Between April 2020 and January 2022, a total of 76 breast cancer patients receiving ALND were reviewed. Forty four of them also received ILR immediately after ALND. The assignment of ILR surgery was non-random, based on patients' willingness and plastic surgeons' availability. The lymphatic vessels in the axillary wound were anastomosed with nearby terminal branches of the axillary vein under surgical microscope. Patients' characteristics, including age, body mass index (BMI), neoadjuvant therapy, type of breast surgery, the occurrence of seroma formation, number of removed lymph nodes, number of positive nodes, and the drainage amount from the operative wounds were compared between ILR and non-ILR groups.

Results

No statistically significant difference was noted between groups in terms of age (56.5 ± 9.8 vs. 60.9 ± 10.7, p = .09), BMI (22.6 ± 3.7 vs. 23.7 ± 3.8, p = .27), type of breast surgery (p = .32), the occurrence of seroma formation (p = 1.0), the likelihood of receiving neoadjuvant therapy (p = .12), number of lymph nodes removed (17.5 ± 7.6 vs. 17.4 ± 8.3, p = .96), or number of positive nodes on final pathology (3.7 ± 5.4 vs. 4.8 ± 8.5, p = .53) except the ILR group had statistically significantly less drainage amount than non-ILR group (39.3 ± 2.6 vs. 48.3 ± 3.7, p = .046).

Conclusion

For breast cancer patients receiving ALND, the immediate lymphatic reconstruction can reduce the postoperative drainage amount from the operative wound.

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即时淋巴重建对乳腺癌腋窝淋巴结清扫术后引流液输出的影响:回顾性比较研究

乳腺癌腋窝淋巴结清扫术(Axillary lymph node dissection, ALND)被认为与多种并发症有关，如术后伤口引流过多，引流液放置时间过长，或短期内形成血肿，或长期发生上肢淋巴水肿。立即淋巴水肿重建(ILR)已被提出，通过在ALND后立即将横断的手臂淋巴与附近的腋窝静脉分支吻合来减少手臂淋巴水肿的发生。本研究旨在证明ILR也可以减少术后引流量。患者和方法回顾了2020年4月至2022年1月期间接受ALND治疗的76例乳腺癌患者。其中44例在ALND后立即接受ILR治疗。ILR手术的分配是非随机的，基于患者的意愿和整形外科医生的可用性。手术显微镜下观察腋窝创面淋巴血管与附近腋窝静脉终支吻合。比较ILR组与非ILR组患者的年龄、体重指数(BMI)、新辅助治疗、乳房手术类型、血肿形成情况、淋巴结清扫数、阳性淋巴结数、手术创面引流量等特征。结果没有统计上的显著差异指出团体之间的年龄(56.5±9.8和60.9±10.7,p = .09点)、体重指数(22.6±3.7和23.7±3.8,p = 10),类型的乳腺癌手术(p = 32)、血清肿的发生形成(p = 1.0),接受新辅助治疗的可能性(p =点),淋巴结切除数目(17.5±7.6和17.4±8.3,p = .96点),或积极的节点数对最终病理(3.7±5.4和4.8±8.5,除ILR组引流量少于非ILR组(39.3±2.6比48.3±3.7,p = 0.046)外，其他组均有统计学意义(p = 0.046)。结论对于乳腺癌ALND患者，即刻淋巴重建可减少术后手术创面引流量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.

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