| Background: lymphedema is an acute,transient or chronic progressive disease of lymphatic system dysfunction and lymphatic transport disorder caused by external(and / or internal)factors,especially in the extremities.Its clinical manifestations are: swelling of some or all of the arms or legs,heavy or tight sensation,limited range of motion of the joints,repeated infections,and hard and thick skin.In addition to secondary lymphedema caused by filariasis,secondary lymphedema after tumor resection with lymph node dissection is the most common.Among them,the report and incidence of secondary lymphedema of breast cancer was the highest(33%-47%).As breast cancer has become the most common diagnosed cancer,the incidence of breast cancer-related lymphedema is increasing year by year.At present,these treatments of lymphedema include non-operative treatment based on comprehensive physiotherapy and surgical treatment based on volume reduction and reconstruction,which can only alleviate symptoms,delay progress and improve quality of life,and cannot achieve the goal of radical cure.Therefore,under the situation that there is no cure,it is an important attempt to shift the focus of treatment to the level of prevention.Among them,there is a lack of standards for the clinical feasibility and effectiveness of ARM and ILR.We intend to use this Meta analysis to determine the clinical significance and value of ARM and ILR in the prevention of breast cancer-related lymphoedema.Objective: To evaluate the clinical feasibility and effectiveness of prophylactic surgery for breast cancer-related lymphedema based on axillary lymph node dissection,and to determine the clinical value of ARM or ILR in the prevention of breast cancer-related lymphedema,so as to provide a basis for the application and standard establishment of ARM or ILR.Methods: The literature knowledge base of prophylactic surgery for breast cancer-associated lymphedema based on axillary lymph node dissection does not limit the number of years and language,and January 28,2023 is the final retrieval time.With breast cancer,lymph node dissection,lymphedema,reverse axillary lymphatic tracer,and the combination of Chinese and English words and synonyms of lymphoid reconstruction in the same period,the published literatures were searched in English databases such as Pubmed,Embase,Webof Science,Cochranelibrary and Chinese databases such as Zhiwang,Wanfang and VIP.In addition,the related studies on preventive surgery for lymphedema were systematically searched,and the references of relevant reviews were reviewed to screen the relevant studies by literature retrospective method.According to the inclusion and exclusion criteria,R4.2.1 was used to analyze the recognition rate of ARM lymph nodes and / or lymphatic vessels,the success rate of ILR operation and the incidence of upper limb lymphedema.The risk results of upper limb lymphedema in patients with preventive surgery for lymphedema were analyzed by subgroup analysis and Meta regression analysis.Results: A total of 45 articles were included,of which 27 were about ARM and18 were about ILR.Among the ARM-related studies,15 were randomized controlled trials and 12 were observational cohort studies.In the ILR study,9 were observational cohort studies and 9 were single-arm clinical studies.The results of Meta analysis of feasibility analysis of ARM in breast cancer surgery showed that in ARM,the recognition rate of lymph nodes and / or lymphatic vessels in ARM was 90.5%(95%CI: 86.2%-94%),the combined OR value of ALND combined ARM group and simple ALND group was 0.19(95%CI: 0.013-0.28),and the incidence of lymphedema of ALND combined with ARM was 6.5%(95%CI:3.9%-9.5%).In patients with ALND combined with ARM,the incidence of BCRL was 5.5%(95%CI: 2.1%-10.7%),6.5%(95%CI: 3%-10.9%),13.0%(95%CI:0.1%-38.6%)and 21.4%(95%CI: 12.5%-32.9%)during follow-up for half a year,1 year,2 years and 3 years,respectively.The feasibility analysis of ILR in breast cancer surgery showed that the success rate of ILR operation was 92.8%(95%CI:88.7%-96.2%),the combined OR value of ALND plus ILR group and simple ALND group was 0.26(95%CI: 0.14-0.49),and the cumulative incidence of lymphedema of ALND combined with ILR was 7.7%(95% CI: 4.9%-10.9%).The incidence of BCRL in ALND patients receiving ILR at 6 months,12 months,12-35 months and 36-60 months was 4.9%(95%CI: 1.7%-9.5%),3.9%(95%CI:1.8%-6.8%),6.2%(95%CI: 0.8%-16.2%),11.8%(95% CI:0-53.3%),respectively.Conclusion: It is feasible for breast cancer patients undergoing ALND to receive ARM or ILR,and ARM or ILR is beneficial to breast cancer patients undergoing ALND.Compared with traditional ALND surgery,ARM or ILR combined with ALND can reduce the risk of BCRL and maintain this advantage in the medium and long term,but the long-term effect of ARM or ILR in reducing the risk of BCRL in patients with ALND needs to be further studied and verified,and to determine whether ARM and ILR have the same effect. |
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