Timing of Surgical Axillary Staging and Impact on Technical Success of Immediate Lymphatic Reconstruction Following Axillary Lymph Node Dissection

BACKGROUND: The impact of sentinel lymph node dissection (SLND) or targeted axillary dissection (TAD) prior to axillary lymph node dissection (ALND) on the technical success of immediate lymphatic reconstruction (ILR) is not well described. We aimed to determine if the technical success of ILR varies by timing of surgical axillary staging prior to ALND. METHODS: Our departmental database was queried to identify patients undergoing ALND from 2020 to 2024. Type and timing of axillary surgical staging and ILR technical details were collected by retrospective chart review. RESULTS: Among 866 patients undergoing ALND with a plan for ILR, 655 (75.6%) underwent single-stage ALND, 120 (13.9%) underwent SLND/TAD followed by ALND under the same anesthetic, and 91 (10.5%) underwent SLND/TAD followed by ALND at a separate surgery. The overall ILR technical success rate was 93.4% (612/655). Immediate lymphatic reconstruction technical success did not vary significantly between groups (p = 0.415). Groups were similar in number of reconstructed lymphatic channels (p = 0.173), with a median of 2 (IQR 1-3) channels. The most common reasons for ILR not being performed (n = 52) included failure to identify blue lymphatic channels by axillary reverse mapping (n = 21) and no suitable veins for the reconstruction (n = 11). On multivariable analysis, White race and lower body mass index were significant predictors of ILR technical success. CONCLUSIONS: In patients undergoing ALND, ILR was successfully performed in > 90% of cases, irrespective of concurrent or staged SLND/TAD procedures. Most patients (62.9%) had at least 2 lymphatic channels reconstructed. Deferring decision-making about completion ALND for final pathology from SLND/TAD does not appear to negatively impact technical success of ILR.