已提出立即淋巴重建（ILR）来降低淋巴水肿发生率。我们研究的主要目的是确定 ILR 是否降低接受腋窝淋巴结清扫术 (ALND) 的患者淋巴水肿的发生率。我们对有或没有 ILR 的 ALND 进行了一项两中心实用研究，采用外科医生水平队列分配，基于关于乳腺外科医生首选的标准实践。通过肢体体积测量、患者自我报告、提供者文件和国际疾病分类第十次修订版 (ICD-10) 代码来评估淋巴水肿。总共，招募了 230 名乳腺癌患者；在意向治疗的基础上，99 例接受了 ALND，131 例接受了 ALND 并伴有 ILR。术前计划进行 ILR 的 131 例患者中，115 例（87.8%）接受了 ILR； 72 例 (62.6%) 由一名乳腺肿瘤外科医师完成，43 例 (37.4%) 由经过专科培训的微血管整形外科医生完成。当单变量分析中肢体体积变化≥10%时，ILR与淋巴水肿风险增加相关，但在倾向评分调整后的多变量分析中则不相关。当包括亚临床淋巴水肿（肢体间体积变化≥5%）时，我们没有发现两个队列之间的肢体体积测量存在统计学上的显着差异，也没有发现两个队列之间的意向治疗等级存在差异或接受治疗的依据。对于所有患者，考虑到患者自我报告、提供者文件和 ICD-10 代码的确定策略，作为单一二元结果测量，接受或未接受 ILR 的患者之间的淋巴水肿发生率没有显着差异。接受 ALND（伴或不伴 ILR）的患者之间的淋巴水肿发生率。© 2024。外科肿瘤学会。

Immediate lymphatic reconstruction (ILR) has been proposed to decrease lymphedema rates. The primary aim of our study was to determine whether ILR decreased the incidence of lymphedema in patients undergoing axillary lymph node dissection (ALND).We conducted a two-site pragmatic study of ALND with or without ILR, employing surgeon-level cohort assignment, based on breast surgeons' preferred standard practice. Lymphedema was assessed by limb volume measurements, patient self-reporting, provider documentation, and International Classification of Diseases, Tenth Revision (ICD-10) codes.Overall, 230 patients with breast cancer were enrolled; on an intention-to-treat basis, 99 underwent ALND and 131 underwent ALND with ILR. Of the 131 patients preoperatively planned for ILR, 115 (87.8%) underwent ILR; 72 (62.6%) were performed by one breast surgical oncologist and 43 (37.4%) by fellowship-trained microvascular plastic surgeons. ILR was associated with an increased risk of lymphedema when defined as ≥10% limb volume change on univariable analysis, but not on multivariable analysis, after propensity score adjustment. We did not find a statistically significant difference in limb volume measurements between the two cohorts when including subclinical lymphedema (≥5% inter-limb volume change), nor did we see a difference in grade between the two cohorts on an intent-to-treat or treatment received basis. For all patients, considering ascertainment strategies of patient self-reporting, provider documentation, and ICD-10 codes, as a single binary outcome measure, there was no significant difference in lymphedema rates between those undergoing ILR or not.We found no significant difference in lymphedema rates between patients undergoing ALND with or without ILR.© 2024. Society of Surgical Oncology.