SO29. Immediate Lymphatic Reconstruction for Prevention of Lymphedema in Patients With Breast Cancer: A National Outcomes and Regional Trends Analysis

PURPOSE: Over the past two decades, microsurgical techniques to address lymphedema have demonstrated promising results. One popular strategy is the Lymphatic Microsurgical Preventive Healing Approach (LYMPHA), in which lymphovenous anastomosis (LVA) is performed at the time of axillary lymph node dissection (ALND) to reduce the risk of future lymphedema. While early evidence supports a protective effect of LYMPHA, most studies have been small, single-center trials. In this study, we leveraged a large insurance claims database to better characterize outcomes of immediate lymphatic reconstruction (ILR) and describe national trends related to LYMPHA adoption. METHODS: Adult female patients with a diagnosis of breast cancer who underwent ALND between 2007 and 2022 were identified within the MerativeTM MarketScan® Research Databases. Adjusted odds of undergoing ILR, both overall and regionally, and of experiencing post-mastectomy lymphedema were calculated. RESULTS: Of all patients treated with mastectomy and ALND, 1.3% underwent ILR. ILR was associated with decreased odds of developing lymphedema (OR 0.83; p=0.04). The frequency of ILR procedures increased in all regions between 2017 and 2022, most dramatically in the Midwest and Eastern U.S. More recent surgery year, younger age, complete mastectomy, and delayed ALND elevated odds of undergoing ILR (p≤0.01). CONCLUSION: The popularity of ILR has grown rapidly since 2017, with significant regional variability. Patients with breast cancer who undergo ILR at the time of ALND are less likely to develop lymphedema.