Efficacy of immediate lymphatic reconstruction after breast cancer surgery: A systematic review and time-course dynamics meta-analysis

Background: Immediate lymphatic reconstruction (ILR) is a prophylactic approach for breast cancer-related lymphedema (BCRL) following axillary lymph node dissection (ALND). This study assessed the preventive effect of ILR by evaluating data from prior studies, with a focus on time-course dynamics. Methods: A systematic review and meta-analysis was performed of 17 studies comparing ALND plus ILR with ALND alone. The primary outcome was BCRL incidence. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses were stratified by follow-up duration (1–48 months). Results: ILR significantly reduced BCRL incidence (RR: 0.37; 95% CI: 0.28–0.49). Time-stratified analysis indicated that the prophylactic effect was robust within the first 2 years postoperatively, peaking at 12 months (RR: 0.13; 95% CI: 0.04–0.46). Limited data beyond two years necessitates further studies to clarify long-term results. Conclusion: ILR reduces BCRL risk, remaining a valuable preventive strategy for breast cancer patients. This benefit remains unclear in the long term, highlighting the need for further high-quality trials with extended surveillance.