Immediate lymphovenous anastomosis is effective in preventing breast cancer-related lymphedema: A systematic review and meta-analysis

Objective: We sought to perform a systematic review and meta-analysis on the efficacy and safety of immediate lymphovenous anastomosis (ILA) in breast cancer. Summary background data: Breast cancer-related lymphedema (BCRL) affects 1 out of 5 patients who undergo treatment for breast cancer and is an incurable and chronic disease. ILA has emerged as a strategy for BCRL prevention with negligible increase in surgical time and high intraoperative success rates. Methods: We systematically searched the PubMed, Embase, and Cochrane databases from inception to May 2024. Inclusion was restricted to: (1) randomized controlled trials (RCTs), prospective, and retrospective controlled studies; (2) comparison of patients with breast cancer who underwent axillary lymph node dissection (ALND) with and without ILA; and (3) reporting outcomes of interest. The primary outcome was BCRL incidence. Secondary outcomes included (1) seroma, (2) hematoma, (3) infection, (4) need for reoperation, (5) distant recurrence, and (5) mortality rates. Results: In the pooled ILA group, 98 of 1026 patients (9.6%) developed lymphedema, in contrast to 584 of 1405 patients (41.6%) in the control group, demonstrating a protective effect of ILA on BCRL rate (risk ratios [RR] 0.35 [0.27–0.47]; p < 0.001; I² = 30%) and yielding a number needed to treat of 3.4. Conclusions and relevance: ILA has a protective effect on BCRL rates in patients undergoing ALND. Further studies are necessary to stratify the subgroups that would benefit the most from ILA and evaluate its effect on long-term cancer recurrence.