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Oncologic safety of axillary lymph node dissection with immediate lymphatic reconstruction

  • Original Laboratory Investigation
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) can reduce the incidence of lymphedema in patients with breast cancer. The oncologic safety of ILR is unknown and has not been reported. The purpose of this study was to evaluate if ILR is associated with increased breast cancer recurrence rates.

Methods

Patients with breast cancer who underwent ALND with ILR from September 2016 to December 2020 were identified from a prospective institutional database. Patient demographics, tumor characteristics, and operative details were recorded. Follow-up included the development of local recurrence as well as distant metastasis. Oncologic outcomes were analyzed.

Results

A total of 137 patients underwent ALND with ILR. At cancer presentation, 122 patients (89%) had clinically node positive primary breast cancer, 10 patients (7.3%) had recurrent breast cancer involving the axillary lymph nodes, 3 patients (2.2%) had recurrent breast cancer involving both the breast and axillary nodes, and 2 patients (1.5%) presented with axillary disease/occult breast cancer. For surgical management, 103 patients (75.2%) underwent a mastectomy, 22 patients (16%) underwent lumpectomy and 12 patients (8.8%) had axillary surgery only. The ALND procedure, yielded a median of 15 lymph nodes pathologically identified (range 3–41).

At a median follow-up of 32.9 months (range 6–63 months), 17 patients (12.4%) developed a local (n = 1) or distant recurrence (n = 16), however, no axillary recurrences were identified.

Conclusion

Immediate lymphatic reconstruction in patients with breast cancer undergoing ALND is not associated with short term axillary recurrence and appears oncologically safe.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to the personal health information contained within. The data are available from the corresponding author upon request.

Abbreviations

ILR :

Immediate lymphatic reconstruction

ALND :

Axillary lymph node dissection

SLNB :

Sentinel lymph node biopsy

LVB :

Lymphovenous bypass

ARM :

Axillary reverse mapping

LYMPHA :

Lymphatic microsurgical preventative healing approach

pCR :

Pathologic complete response

NAC :

Neoadjuvant chemotherapy

RCB :

Residual cancer burden

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Division of Breast Surgery, Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Hope M. Guzzo, Stephanie A. Valente, Ayat ElSherif, Julie E. Lang, Debra Pratt & Zahraa Al-Hilli

  2. Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA

    Graham S. Schwarz, Cagri Cakmakoglu, Risal Djohan & Steven Bernard

  3. Cleveland Clinic Abu Dhabi, Oncology Institute, Abu Dhabi, United Arab Emirates

    Stephen R. Grobmyer

Authors
  1. Hope M. Guzzo
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  2. Stephanie A. Valente
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  4. Ayat ElSherif
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  5. Stephen R. Grobmyer
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  6. Cagri Cakmakoglu
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  11. Zahraa Al-Hilli
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by HG, AE, SV, CC and ZAH. The first draft of the manuscript was written by HG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Zahraa Al-Hilli.

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Conflict of interest

Author Stephanie Valente, DO is a speaker/consultant/advisory board member for Impedimed, Pacira, AxoGen, Merit. The remaining authors have no conflicts of interest. The corresponding author has signed the disclosure form and attached it with the manuscript stating there is no conflict of interest. Separate conflict of interest forms from remaining authors can be uploaded if needed.

Ethical approval

This study received IRB approval.

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Guzzo, H.M., Valente, S.A., Schwarz, G.S. et al. Oncologic safety of axillary lymph node dissection with immediate lymphatic reconstruction. Breast Cancer Res Treat 196, 657–664 (2022). https://doi.org/10.1007/s10549-022-06758-2

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  • DOI: https://doi.org/10.1007/s10549-022-06758-2

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