{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:49:22Z","timestamp":1789123762759,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immediate lymphatic reconstruction (ILR) is a technique in which lymphatics are visualized and lymphovenous bypass is done at the time of axillary lymph node dissection (ALND) to prevent breast cancer\u2010related lymphedema (BCRL). This meta\u2010analysis estimates the benefit of ILR in preventing lymphedema by incorporating double\u2010 and single\u2010arm studies and stratifying by length of follow\u2010up time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Three databases were queried for studies with primary data on ILR. Both double\u2010 and single\u2010armed studies were included, and papers with small sample sizes, overlapping samples, and unreported data were excluded. Treatment effects were calculated with risk ratios and converted to a logarithmic scale. A meta\u2010analysis was performed using the inverse variance method and a random\u2010effects model, with further analysis done by study design and length of follow\u2010up time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 17 studies were included (9 double\u2010arm and 8 single\u2010arm;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092607). The pooled treatment effect of ILR, expressed as log risk ratio (95% CI), was \u22120.89 (\u22121.18, \u22120.60;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). This corresponds to a relative risk of 0.41 (0.31, 0.55) and a number needed to treat of 9. Double\u2010 and single\u2010arm studies showed no significant differences in effect sizes. Studies with &lt;\u20091\u2010year follow\u2010up demonstrated a larger effect size than those with longer follow\u2010up, and the benefits of ILR were no longer significant past 3\u2009years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients receiving ILR were significantly less likely to develop BCRL than those receiving ALND alone. Further work is needed to examine whether benefits can truly be sustained long\u2010term.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70109","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:40:58Z","timestamp":1756291258000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy of Immediate Lymphatic Reconstruction in Prevention of Breast Cancer\u2010Related Lymphedema: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6339-6717","authenticated-orcid":false,"given":"May X.","family":"Li","sequence":"first","affiliation":[{"name":"Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Zhang","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine 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