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P84. Prophylactic lymphovenous bypass at the time of axillary lymph node dissection for lymphedema prevention: A retrospective study of lymphedema rates

Friday, March 6, 2026
2:58 PM - 3:05 PM MST
Location: 105A-C
Introduction: Chronic lymphedema affects 30%-70% of patients who undergo axillary lymph node dissection (ALND). While studies have reported prophylactic lymphovenous bypass (pLVB) as an effective measure to prevent lymphedema after ALND, outcomes and complication rates are still underreported in literature due to small patient populations and short follow-up. The aim of this study was to report a real-world experience of implementing a pLVB program and evaluate its outcomes for patients who underwent ALND due to malignancy at a comprehensive cancer center.


Methods: This was a single-institution retrospective review from 2023 to 2025 examining surgeons' experiences and outcomes of ALND+pLVB in patients with breast and cutaneous malignancies. Patients were evaluated by physical therapy lymphedema specialists, and lymphedema was measured with limb volumes or International Society of Lymphology (ISL) staging. Institutional ALND+pLVB rates were compared to national reported ALND without pLVB with a one-sample exact binomial test. Two-tailed p values less than 0.05 were considered statistically significant, and exact 95% confidence intervals (Clopper–Pearson) were calculated.


Results:

44 patients were included, with a mean age of 58 years at the time of surgery. 86% of patients were female (n=38).  Patients were diagnosed with breast cancer (n=35), melanoma (n=7), or squamous cell carcinoma (n=2). 22 patients received neoadjuvant chemotherapy or immunotherapy, and 19 received adjuvant radiation.  

All patients underwent ALND followed by immediate pLVB in the axillary surgical field. No major perioperative or postoperative complications were documented. The average operative length was 269 minutes, and a mean of two anastomoses were performed for pLVB. Drains were maintained for a mean of 19 days after surgery.   

At a median follow-up of 12.5 months, lymphedema occurred in 11.4% of patients (5/44; 95% CI, 3.8%-24.6%), with an average time of 152 days noted between surgery and lymphedema onset. When compared to national rates of lymphedema after ALND, institutional rates were significantly lower than the national reported incidence of 30% (p =0.007). 


Conclusions: pLVB reduces rates of lymphedema after ALND without increasing postoperative complications. A multidisciplinary approach can substantially decrease morbidity in this patient population. Further studies with longer follow-up will help define the potential benefits, cost, and long term outcomes of pLVB for patients requiring ALND.

Learning Objectives:

  • Describe the incidence and consequences of malignancy-related lymphedema following axillary lymph node dissection (ALND).
  • Explain the role and technique of prophylactic lymphovenous bypass (pLVB) in reducing postoperative lymphedema rates after ALND.
  • Interpret the outcomes of a multicenter retrospective study evaluating pLVB effectiveness compared to nationally reported ALND rates without pLVB.