Oncologic Safety of Axillary Lymph Node Dissection with Immediate Lymphatic Reconstruction

Abstract

Abstract Purpose: Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) can reduce the incidence of lymphedema in breast cancer patients. The oncologic safety of ILR has not been reported. The purpose of this study was to evaluate if ILR is associated with increased breast cancer recurrence rates. Methods: Breast cancer patients 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 (16.0%) underwent lumpectomy and 12 patients (8.8%) had axillary surgery only. The ALND procedure, yielded a median of 15 lymph nodes removed (range 3-41). At a median follow-up of 32.9 months (range 6-63 months) no axillary recurrences were identified. Conclusion: Immediate lymphatic reconstruction in breast cancer patients undergoing ALND is not associated with short term axillary recurrence and appears oncologically safe.