Investigating the oncological impact of immediate lymphatic reconstruction within patients with upper and lower limb malignancy: A PRISMA systematic review

Abstract Background There are several studies discussing the lymphoedema-related outcomes of immediate lymphatic reconstruction, but there is a dearth of literature reporting on the subsequent oncological outcomes. A major concern is the potential for an increased metastasis. The systematic review aims to investigate the potential for increased metastasis and decreased cancer-related survival in patients with upper and lower limb malignancies who underwent lymphatic reconstructive procedures post-lymph node dissection. Methods A systematic literature review was conducted in accordance with the PRISMA guidelines. literature search was carried out on the MEDLINE and Embase Databases, with additional searches carried out on PubMed Central and Google Scholar. All (in vivo) studies reporting cancer-related outcomes relating to patients who had an upper or lower limb malignancy and underwent lymphatic reconstruction post-lymph node dissection (either lymphovenous anastomosis (LVA) and vascularised lymph node transplants (VLNT); several studies reporting on outcomes post-LVA were found, no data for VLNT was found). Results Limited, low-quality data suggests prophylactic post-inguinal LVA may be associated with reduced overall survival and increased recurrence and metastasis in lower limb melanoma and squamous cell carcinoma. Evidence for LVA following pelvic malignancy is sparse and lacks adequate control or follow-up data to draw definitive conclusions. In breast-cancer related lymphoedema, LVA appears oncologically safe in the short term with no observed increase in locoregional recurrence or distant metastasis. However, most studies lacked control groups and had follow-up periods under 36 months. Conclusions Lymphovenous anastomoses presents a promising approach for reducing the burden of lymphoedema following a lymph node dissection. The evidence presented in this review suggests that while ILR may be safe in patients with breast and pelvic malignancies, concerns remain for patients with melanoma and squamous cell carcinoma of the lower extremities, where some studies have reported higher rates of recurrence and reduced survival—although these findings are based on small, retrospective cohorts with limited follow-up. Current evidence is limited and heterogenous; larger, prospective studies with long-term follow-up are needed to clarify safety. Evidence Level: Not gradable.