{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T08:58:42Z","timestamp":1790585922095,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative pathways designed to reduce surgical stress, accelerate recovery, and improve resource utilization. Although ERAS principles have been increasingly adopted in microsurgery, their application in vascularized lymph node transfer (VLNT), particularly using gastroepiploic flaps, remains poorly defined. The aim of this study was to evaluate the feasibility, safety, and effectiveness of a tailored ERAS protocol in patients undergoing gastroepiploic VLNT for breast cancer\u2010related upper extremity lymphedema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>A retrospective comparative study was conducted in patients with unilateral breast cancer\u2010related upper extremity lymphedema (ISL Stage II\u2013III) undergoing gastroepiploic vascularized lymph node transfer after failure of at least 6 months of conservative treatment. Patients were managed either with a conventional perioperative protocol, including nasogastric tube placement, delayed oral intake, delayed mobilization, opioid\u2010based analgesia, and delayed initiation of complete decongestive therapy (CDT), or with a tailored ERAS\u2010VLNT protocol incorporating early oral intake, early mobilization, opioid\u2010sparing analgesia, avoidance of nasogastric decompression, and CDT initiation from postoperative Day 7. Outcomes included circumferential reduction rate, LYMQOL score, infection rate, flap\u2010related complications, length of hospital stay, and hospitalization costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 45 patients were included, with 29 in the ERAS group and 16 in the conventional group. Baseline demographic and clinical characteristics were comparable between groups. The ERAS group demonstrated a significantly shorter hospital stay (2.34\u2009\u00b1\u20090.48 vs. 5.56\u2009\u00b1\u20090.51\u2009days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and lower estimated hospitalization costs (\u20ac1400 vs. \u20ac3300,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Flap survival was 100% in both groups, with no flap\u2010related complications. Circumferential reduction rate was comparable between groups (44.39%\u2009\u00b1\u200910.20% vs. 47.53%\u2009\u00b1\u20098.26%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.278), as were LYMQOL scores at 12\u2009months (8.21\u2009\u00b1\u20090.73 vs. 7.93\u2009\u00b1\u20090.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.236) and infection rates (2.62\u2009\u00b1\u20090.90 vs. 2.73\u2009\u00b1\u20090.96 episodes\/year,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.71).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An ERAS\u2010based protocol tailored to VLNT is feasible and safe, and is associated with improved perioperative recovery and reduced healthcare costs without evidence of compromised surgical or functional outcomes. These findings support the integration of ERAS principles into lymphatic microsurgery and warrant further prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70294","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:43:25Z","timestamp":1789969405000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of the Feasibility, Safety, and Effectiveness of a Tailored Enhanced Recovery After Surgery Protocol for Gastroepiploic Vascularized Lymph Node Transfer in Breast Cancer\u2010Related Upper Extremity Lymphedema: A Preliminary Retrospective Comparative Study"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8901-3614","authenticated-orcid":false,"given":"Federico","family":"Lo Torto","sequence":"first","affiliation":[{"name":"Unit of Plastic and Reconstructive Surgery, Department of Medical, Oral, and Biotechnological Sciences University \u201cG. d'Annunzio\u201d of Chieti\u2013Pescara  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5278-232X","authenticated-orcid":false,"given":"Bilel","family":"Dribine","sequence":"additional","affiliation":[{"name":"Unit of Plastic and Reconstructive Surgery, Department of Surgery, Policlinico Umberto I Sapienza University of Rome  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7095-2010","authenticated-orcid":false,"given":"Alessia","family":"Pagnotta","sequence":"additional","affiliation":[{"name":"Unit of Plastic and Reconstructive Surgery, Department of Surgery, Policlinico Umberto I Sapienza University of Rome  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7378-8431","authenticated-orcid":false,"given":"Andrea","family":"Loreti","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Azienda Ospedaliera San Giovanni\u2010Addolorata  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7121-2295","authenticated-orcid":false,"given":"Giuseppe","family":"Cavallaro","sequence":"additional","affiliation":[{"name":"Unit of General Surgery, ICOT Hospital (LT), Department of Surgery \u201cSapienza\u201d University of Rome  Roma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Agenzia Nazionale per i Servizi Sanitari Regionali (AGENAS). n.d.\u201cAnalisi dei Costi Ospedalieri e Variabilit\u00e0 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dello Stato. n.d.\u201cMonitoraggio Della Spesa 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