Browsing by Subject "Axillary lymph node dissection (ALND)"

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    P33. A Multi-hospital Network Analysis of Long-term Outcomes and Predictors of Lymphedema Following Immediate Lymphatic Reconstruction and Axillary Lymph Node Dissection
    (Wolters Kluwer, 2025-05-16) Hassan, Abbas M.; Hajj, John P.; Lewis, John P.; Ahmed, Shahnur; Fisher, Carla S.; Ludwig, Kandice K.; Danforth, Rachel M.; VonDerHaar, R. Jason; Bamba, Ravinder; Lester, Mary E.; Hassanein, Aladdin H.; Surgery, School of Medicine
    PURPOSE: Breast cancer-related lymphedema (BCRL) significantly affects quality-of-life after axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) may reduce BCRL incidence, but long-term outcomes and predictors are unclear. This study sought to compare long-term BCRL prevalence in patients undergoing ILR with pooled estimates from ALND alone and to identify factors associated with BCRL after ILR. METHODS: We retrospectively studied consecutive patients who underwent ILR following ALND between January 2020 and March 2024 across six hospitals in the Indiana University network. Primary outcome was BCRL prevalence, defined as ≥2cm limb difference at two contiguous points. Secondary outcomes included BCRL predictors, postoperative complications, and compression garment use. RESULTS: Among 150 patients (mean age 51.2±10.6 years; BMI 29.6±7.1 kg/m²; follow-up 17.9±10.8 months) that underwent ILR, cumulative BCRL incidence was 10.7% (n=16). Compared to pooled estimates from 10,774 patients undergoing ALND alone, our ILR cohort had significantly lower BCRL rates: 2% vs. 16.5% (<12 months), 6.7% vs. 24.6% (12-24 months), and 10.7% vs. 23.6% (>24 months) (p < 0.001). Compression was used in 29% following ILR, with 64.6% (n=28) not meeting lymphedema diagnostic criteria. Breast-related complications occurred in 29.3% (n=44). Patients with obesity (56.3% vs. 38.3%, p=0.179) and postoperative radiotherapy (93.8% vs. 82.8%, p=0.260) had higher rates of lymphedema following ILR, although not statistically significant. Multivariable analysis did not identify any independent predictors of BCRL among ILR patients. CONCLUSION: ILR following ALND is associated with significantly lower rates of BCRL compared to ALND alone. The prevalence of lymphedema increases over time with longer term follow-up.
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    Prophylactic Buried Dermal Flap: A Simple Method for Axillary Reconstruction after Lymph Node Dissection
    (Wolters Kluwer, 2024-09-12) Fallah, Kasra N.; Ahmed, Shahnur; Venardi, Andrew S.; Hulsman, Luci A.; Fisher, Carla S.; Ludwig, Kandice K.; Lester, Mary E.; Hassanein, Aladdin H.; Surgery, School of Medicine
    Breast cancer-related lymphedema is characterized by progressive limb enlargement and occurs in up to 30% of breast cancer patients following axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) is a preventative technique used to reduce lymphedema rates by performing lymphovenous anastomoses of disrupted afferent lymphatics. This study presents a novel method of axillary reconstruction following ALND using a buried dermal flap that provides local tissue with intact subdermal lymphatics to the axillary dead space. A single-center retrospective review was performed to assess breast cancer patients who underwent modified radical mastectomy without reconstruction between 2018 and 2023. Groups were divided into those who had ILR alone (group 1) and those who had buried dermal flap with attempted ILR (group 2). There were 31 patients included in this study: 18 patients in group 1 and 13 patients in group 2. Patient demographics, comorbidities, and breast cancer history were similar between the groups. There was no significant difference in the mean number of lymphovenous anastomoses performed (1.6 versus 1.7, P = 0.84). Mean operative time of 224.4 ± 51.9 minutes in group 1 was similar to 223.4 ± 30.4 minutes in group 2 (P = 0.95). We introduce a novel method of axillary reconstruction following ALND using a buried dermal flap that is inset into the axillary dissection space and over the area of ILR. We propose that it is an efficient accessory procedure to augment ILR by providing supplementary intact lymphatic channels to the area of lymphatic injury, while obliterating the axillary dead space.