{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:04:12Z","timestamp":1790024652669,"version":"4.0.1"},"reference-count":72,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T00:00:00Z","timestamp":1645747200000},"content-version":"vor","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Indian J Plast Surg"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Background\u2003Several studies have proven prophylactic lymphovenous anastomosis (LVA) performed after lymphadenectomy can potentially reduce the risk of cancer-related lymphedema (CRL) without compromising the oncological treatment. We present a systematic review of the current evidence on the primary prevention of CRL using preventive lymphatic surgery (PLS).<\/jats:p><jats:p>Patients and Methods\u2003A comprehensive search across PubMed, Cochrane-EBMR, Web of Science, Ovid Medline (R) and in-process, SCOPUS, and ScienceDirect was performed through December 2020. A meta-analysis with a random-effect method was accomplished.<\/jats:p><jats:p>Results\u2003Twenty-four studies including 1547 patients fulfilled the inclusion criteria. Overall, 830 prophylactic LVA procedures were performed after oncological treatment, of which 61 developed lymphedema.<\/jats:p><jats:p>The pooled cumulative rate of upper extremity lymphedema after axillary lymph node dissection (ALND) and PLS was 5.15% (95% CI, 2.9%\u20137.5%; p\u2009&lt;\u20090.01). The pooled cumulative rate of lower extremity lymphedema after oncological surgical treatment and PLS was 6.66% (95% CI\u2009&lt;\u20091\u201313.4%, p-value\u2009=\u20090.5). Pooled analysis showed that PLS reduced the incidence of upper and lower limb lymphedema after lymph node dissection by 18.7 per 100 patients treated (risk difference [RD] \u2013 18.7%, 95% CI \u2013 29.5% to \u2013 7.9%; p\u2009&lt;\u20090.001) and by 30.3 per 100 patients treated (RD \u2013 30.3%, 95% CI \u2013 46.5% to \u2013 14%; p\u2009&lt;\u20090.001), respectively, versus no prophylactic lymphatic reconstruction.<\/jats:p><jats:p>Conclusions\u2003Low-quality studies and a high risk of bias halt the formulating of strong recommendations in favor of PLS, despite preliminary reports theoretically indicating that the inclusion of PLS may significantly decrease the incidence of CRL.<\/jats:p>","DOI":"10.1055\/s-0041-1740085","type":"journal-article","created":{"date-parts":[[2022,2,26]],"date-time":"2022-02-26T00:13:02Z","timestamp":1645834382000},"page":"018-025","source":"Crossref","is-referenced-by-count":30,"title":["Primary Prevention of Cancer-Related Lymphedema Using Preventive Lymphatic Surgery: Systematic Review and Meta-analysis"],"prefix":"10.1055","volume":"55","author":[{"given":"Pedro","family":"Ciudad","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru"},{"name":"Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan"},{"name":"Academic Department of Surgery. School of Medicine Hipolito Unanue. Federico Villarreal National University, Lima, Per\u00fa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Escand\u00f3n","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria P.","family":"Bustos","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar J.","family":"Manrique","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juste","family":"Kaciulyte","sequence":"additional","affiliation":[{"name":"Department of Surgery \u201cP.Valdoni,\u201d Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,2,25]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1055\/s-0039-1688537","article-title":"Surgical management of lower extremity lymphedema: a comprehensive review","volume":"52","author":"P Ciudad","year":"2019","journal-title":"Indian J Plast Surg"},{"issue":"09","key":"ref2","doi-asserted-by":"crossref","first-page":"H1065","DOI":"10.1152\/ajpheart.00598.2014","article-title":"Regulation of inflammation and fibrosis by macrophages in lymphedema","volume":"308","author":"S Ghanta","year":"2015","journal-title":"Am J Physiol 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