Immediate lymphatic reconstruction for prevention of secondary lymphedema in cancer patients: A meta-analysis of 42 studies

Abstract

Background

Secondary lymphedema, a common complication following lymph node dissection, affecting up to 53% of cancer survivors, imposes significant morbidity and reduced quality of life. Immediate lymphatic reconstruction (ILR) has emerged as a preventive strategy; however, its efficacy remains unclear.

Methods

We conducted a PRISMA/AMSTAR-compliant systematic review and meta-analysis. A comprehensive search of PubMed, EMBASE, and Web of Science (2009–2024) identified studies evaluating ILR for lymphedema prevention. Random-effects models were used to calculate pooled odds ratios (ORs) for comparative studies and pooled incidence proportions for single-arm studies, each with 95% confidence intervals (CIs). Subgroup analyses examined extremity site, follow-up duration, BMI, and study design. Publication bias was assessed with funnel plots and Egger’s test.

Results

We included 42 studies with a total of 4539 patients. Among comparative studies, ILR was associated with roughly a 75% reduction in lymphedema risk (pooled OR = 0.25, 95% CI 0.17–0.36, p=0.004). A temporal decline in ILR’s protective effect was observed: OR 0.11 at <1 year follow-up versus OR 0.41 at ≥2 years (p=0.003). Across 19 single-arm studies, the pooled lymphedema incidence after ILR was 7.34% (95% CI 4.97–10.71%), rising to ∼20% in studies with >2 years of follow-up. Heterogeneity among studies was moderate (I² = 51%). Funnel plots indicated potential publication bias in comparative studies (Egger’s test: z=−2.14, p=0.032), but not in single-arm studies (p=0.105).

Conclusion

ILR reduces the risk of cancer-related secondary lymphedema, particularly for breast cancer patients in the early postoperative period. Standardized surgical protocols and prolonged follow-up are needed to optimize and confirm long-term benefits.