Immediate and delayed lymphatic reconstruction of breast-cancer related lymphedema: A systematic review and network meta-analysis.

[BACKGROUND] Breast cancer-related lymphedema (BCRL) is a significant morbidity due to its negative impact on physical, social, and psychological well-being. The objective of this work was to systematically evaluate the evidence for the efficacy of these surgical techniques in the preventive and curative treatment of BCRL by comparing the techniques with each other in an updated review and network meta-analysis of the literature.

[METHODS] PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and Google Scholar databases were queried from January 2010 to March 2025.

[RESULTS] In the preventive setting, the pooled random-effects model showed a significant reduction in BCRL compared to the control for both axillary reverse mapping (odds ratio [OR] = 0.28; 95% confidence interval [CI] = 0.19-0.41) and lymphovascular anastomoses (OR = 0.25; 95% CI = 0.15-0.41), without difference between those technique (OR = 1.06; 95% CI = 0.60-1.87). In the curative setting, both LVA and vascularized lymph node transfer showed a benefit toward surgery for the upper extremity lymphedema index (UEL) and changes in excess volume/circumference. There was no difference between those techniques in terms of efficacy. Quality of life improved after curative surgery (standardized mean difference = 2.60; 95% CI = 1.17-4.02).

[CONCLUSIONS] The literature data suggest that preventive and curative surgery techniques are safe and effective, with a real impact on improving the lives of breast cancer survivors.