Immediate lymphatic reconstruction (ILR) for prevention of secondary lymphedema after breast cancer surgery: a systematic review and meta‑analysis.

Abstract

Background: The most common chronic complication following breast cancer surgery is breast cancer-related lymphedema (BCRL). Lymphovenous anastomosis (LVA) is a surgical treatment for lymphedema, but it could not cure lymphedema. Immediate lymphatic reconstruction (ILR) has been shown in early studies to reduce the risk of BCRL. The objective of this study is to detail the impact of ILR on the incidence of BCRL and to summarize the current opportunities and challenges of ILR.

Methods: We performed a systematic review through September 2024 of the Web of Science, Embase, and PubMed databases. There were cohort studies that documented the incidence of BCRL having undergone ILR. BCRL occurrences between the ILR and no ILR group were compared using a comparative meta-analysis of five studies. Additionally, a single percentage meta-analysis was conducted using 12 papers that documented the events of BCRL after ILR.

Results: The 12 papers included all met the criteria for analysis. The incidence of BCRL in the no ILR group was higher than that in the ILR group, according to a comparative meta-analysis, and there was a statistically significant difference [odds ratio (OR): 0.14; 95% confidence interval (CI): 0.08-0.24; P<0.001]. Besides, the incidence of BCRL of the IRL group was 8.6% (95% CI: 6-12%), according to a meta-analysis of single percentages. The results of the subgroup analysis showed that follow-up time of less than 1 year or more than 1 year after ILR was not significantly associated with the incidence of BCRL (P=0.40).

Conclusions: There is a definite indication that ILR is beneficial in preventing BCRL. This might be a helpful intervention for improving the quality of life of breast cancer survivors.