ILR to Prevent BRCL_MCC 23608

Summary

The goal of this clinical trial is to evaluate the effectiveness of Immediate Lymphatic Reconstruction (ILR) in preventing breast cancer-related lymphedema (BCRL) in high-risk patients. It will also assess the safety and quality of life outcomes associated with the procedure. The main questions it aims to answer are: Does ILR reduce the incidence of BCRL in patients undergoing axillary lymph node dissection (ALND)? What are the patient-reported outcomes and quality of life differences between those who receive ILR and those who do not? Participants will be identified as high-risk for developing BCRL through a multidisciplinary tumor board and referred to a specialized clinic for further evaluation. High-risk patients will undergo a series of screening tests, including bioimpedance spectroscopy (BIS), circumferential limb measurements, and infrared 3D perometry. Participants will be randomly assigned to one of two groups: Intervention Group (Study Arm A): Undergo ILR during ALND surgery, where preserved lymphatic channels are connected to nearby veins to prevent lymphedema. Control Group (Study Arm B): Will not receive ILR, but efforts will be made to preserve lymphatic channels during surgery. Patients will be blinded to their group assignment. Post-surgery, all participants will receive education from a certified lymphatic physical therapist. At the 2-week postoperative visit, participants will be further randomized into two postoperative monitoring protocols: BCRL Clinical Pathway: Patients will have regular follow-up visits every three months for two years, including repeat BIS, limb measurements, perometry, and quality of life questionnaires (LYMQOL and ULL-27). Standard of Care: Patients will be monitored only if they experience BCRL symptoms or after two years from ALND. The study will compare the outcomes of both groups, with a focus on the incidence of BCRL and patient quality of life, and will benchmark these results against published literature on breast cancer patients.

Eligibility

Inclusion Criteria:

* Patients consenting for unilateral ALND \[prior history of sentinel lymph node biopsy (SLNBx) allowed if \<6 months from consent\]
* Patients consenting for unilateral SLNBx with possible ALND, with a clinically or radiographically positive lymph node OR a high likelihood of ALND per the Breast Surgeon
* Identification of at least one transected lymphatic channel and at least one vein to be used for bypass at the time of ALND during surgery
* Female breast cancer patients 18-75 years of age (inclusive)

Exclusion Criteria:

* • Male breast cancer patients

  * Non-English speaking participants
  * Female breast cancer patients with axillary recurrence
  * Female breast cancer patients who have a history of ALND
  * Female patients requiring bilateral ALND for the treatment of their breast cancer
  * Female breast patients treated with SLNBx only
  * Primary lymphedema of the affected upper limb
  * Secondary lymphedema of the affected limb prior to the lymphadenectomy
  * Radiotherapy at the axilla before the study / surgery
  * Life expectancy \< 2 years for any reason
  * Pregnancy or nursing
  * Substance abuse (such as alcohol or drug abuse) within 6 months prior to screening
  * Severe psychiatric disease
  * Distant metastases at the time of preoperative screening

Conditions3

Locations3 sites

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