乳腺癌的最新进展已朝着侵袭性较小的腋窝手术方向发展。然而，在特定情况下，腋窝淋巴结清扫术（ALND）仍然是必要的，并且会增加淋巴水肿的风险。进行 ALND 并结合立即淋巴重建 (ILR) 有助于降低这种风险。本报告概述了腋窝手术转诊计划 (ASRP) 的实施情况，以扩大 ILR 的获取范围，为考虑类似举措的机构提供见解。一项回顾性研究分析了 2017 年 1 月 6 日期间在贝斯以色列女执事医疗中心 (BIDMC) 转诊至 ASRP 的患者2022 年 12 月 10 日。从前瞻性登记中识别患者，随后从电子病历中提取数据。该分析特别针对从外部机构转诊接受 ILR 的 ALND 的患者。该计划收到了来自五个不同州机构的 131 名患者的转诊。随着时间的推移，年度推荐量稳步增加。转诊的主要指征是新辅助化疗后残留的腋窝疾病（41.2%）。在转诊的患者中，20 名患者 (15.3%) 由于腋窝病理学对新辅助治疗完全缓解而不再需要 ALND。护理协调在简化患者护理流程以提高效率和效果方面发挥了至关重要的作用。ASRP 扩大了乳腺癌患者获得 ILR 的机会，其中大多数患者在化疗后转诊进行残留病灶的手术治疗。该计划为旨在建立类似的专业转诊服务的医疗保健机构提供了一个模型。持续的计划评估将有助于完善腋窝手术转诊实践并确保最佳的患者护理。© 2023。外科肿瘤学会。

Recent advances in breast cancer have progressed toward less aggressive axillary surgery. However, axillary lymph node dissection (ALND) remains necessary in specific cases and can increase the risk of lymphedema. Performing ALND with immediate lymphatic reconstruction (ILR) can help lower this risk. This report outlines the implementation of an Axillary Surgery Referral Program (ASRP) to broaden access to ILR, providing insights for institutions considering similar initiatives.A retrospective study analyzed patients referred to the ASRP at Beth Israel Deaconess Medical Center (BIDMC) between 6 January 2017 and 10 December 2022. Patients were identified from a prospective registry, with data subsequently extracted from electronic medical records. This analysis specifically centered on patients referred from external institutions to undergo ALND with ILR.The program received referrals for 131 patients from institutions across five different states. Annual referrals steadily increased over time. The primary indication for referral was residual axillary disease after neoadjuvant chemotherapy (41.2%). Among the referrals, 20 patients (15.3%) no longer required ALND due to axillary pathologic complete response to neoadjuvant therapy. Care coordination played a crucial role in streamlining the patient care process for both efficiency and effectiveness.The ASRP expands access to ILR for patients with breast cancer, the majority referred for surgical management of residual disease after chemotherapy. The program provides a model for health care institutions aiming to establish similar specialized referral services. Continued program evaluation will be instrumental in refining axillary surgery referral practices and ensuring optimal patient care.© 2023. Society of Surgical Oncology.