Supermicrosurgery lymphaticovenous and lymphaticolymphatic anastomosis: Technical detail and short-term follow-up for immediate lymphatic reconstruction in breast cancer treatment-related lymphedema prevention

•Type of Research: Single-center retrospective cohort study•Key Findings: Immediate supermicrosurgery lymphatic reconstruction is technically feasible after ALND, with the 1-year and 2-year BCRL rate being 14% (95% CI 4.0-23.9%) and 22% (95% CI 10.1-33.9%), respectively.•Take Home Message: In breast cancer patients who have ALND, immediate lymphatic reconstruction with supermicrosurgery technique is a feasible surgical technique for primary prevention of BCRL, although comparison with the control group and long-term follow-up should be elaborated to confirm the effectiveness. ObjectiveTo describe the feasibility and short-term outcome of our surgical technique to repair the lymph vessel disruption directly after axillary lymph node dissection (ALND) during breast cancer surgery. This is called immediate lymphatic reconstruction to prevent breast cancer treatment-related lymphedema (BCRL), which frequently occurs after ALND. The surgical technique consisted of lymphaticovenous anastomosis (LVA) or lymphaticolymphatic anastomosis. We named the procedure lymphatic bypass supermicrosurgery (LBS).MethodThis study used a retrospective cohort design of breast cancer patients between May 2020 and February 2023. LBS was performed by making an intima-to-intima coaptation between afferent lymph vessels and the recipient's veins (LVA) or efferent lymph vessels lymphaticolymphatic anastomosis.ResultA total of 82 patients underwent lymphatic bypass. The mean age of patients was 50 + 12 years old, and most had stage III breast cancer 59 (72%). LVA was the most common type of lymphatic bypass (94.6%). The median number of LVA was 1 (1-4) and 1 (1-3) for lymphaticolymphatic anastomosis. The median follow-up time was 12.5 (1-33) months. The 50 patients that had postoperative ICG lymphography described arm dermal backflow (ADB) stage 0 in 20 (40%), stage 1 in 19 (38%), stage 2 in 2 (4%), and stage 3 in 9 (18%) cases. The proportion of BCRL was 11 (22%), and subclinical lymphedema (SCL) was 19 (38%) in this period. Most cases were in stable SCL (10, 58.8%). The 1-year and 2-year BCRL rates were 14% (95% CI, 4.0-23.9%) and 22% (95% CI, 10.1-33.9%), respectively.ConclusionAlong with the emerging immediate lymphatic reconstruction, LBS is a feasible supermicrosurgery technique that may have a potential role in BCRL prevention. A randomized control study would confirm the effectiveness of the technique. To describe the feasibility and short-term outcome of our surgical technique to repair the lymph vessel disruption directly after axillary lymph node dissection (ALND) during breast cancer surgery. This is called immediate lymphatic reconstruction to prevent breast cancer treatment-related lymphedema (BCRL), which frequently occurs after ALND. The surgical technique consisted of lymphaticovenous anastomosis (LVA) or lymphaticolymphatic anastomosis. We named the procedure lymphatic bypass supermicrosurgery (LBS). This study used a retrospective cohort design of breast cancer patients between May 2020 and February 2023. LBS was performed by making an intima-to-intima coaptation between afferent lymph vessels and the recipient's veins (LVA) or efferent lymph vessels lymphaticolymphatic anastomosis. A total of 82 patients underwent lymphatic bypass. The mean age of patients was 50 + 12 years old, and most had stage III breast cancer 59 (72%). LVA was the most common type of lymphatic bypass (94.6%). The median number of LVA was 1 (1-4) and 1 (1-3) for lymphaticolymphatic anastomosis. The median follow-up time was 12.5 (1-33) months. The 50 patients that had postoperative ICG lymphography described arm dermal backflow (ADB) stage 0 in 20 (40%), stage 1 in 19 (38%), stage 2 in 2 (4%), and stage 3 in 9 (18%) cases. The proportion of BCRL was 11 (22%), and subclinical lymphedema (SCL) was 19 (38%) in this period. Most cases were in stable SCL (10, 58.8%). The 1-year and 2-year BCRL rates were 14% (95% CI, 4.0-23.9%) and 22% (95% CI, 10.1-33.9%), respectively. Along with the emerging immediate lymphatic reconstruction, LBS is a feasible supermicrosurgery technique that may have a potential role in BCRL prevention. A randomized control study would confirm the effectiveness of the technique.