Effect of manual lymphatic drainage on prevention and treatment of lymphedema after breast cancer surgery: a meta-analysis of randomized controlled trials
10.3760/cma.j.cn114453-20240508-00121
- VernacularTitle:徒手淋巴引流对乳腺癌术后淋巴水肿预防与治疗效果的meta分析
- Author:
Chengfei LI
1
;
Shiyi LI
1
;
Hongfan DING
1
;
Minliang CHEN
1
Author Information
1. 解放军总医院第四医学中心烧伤整形医学部，北京 100048
- Publication Type:Journal Article
- Keywords:
Lymphedema;
Manual lymphatic drainage;
Breast cancer-related lymphedema;
Axillary web syndrome;
Meta-analysis
- From:
Chinese Journal of Plastic Surgery
2025;41(3):277-286
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To systematically evaluate the effectiveness of manual lymphatic drainage (MLD) in the prevention and treatment of breast cancer-related lymphedema (BCRL).Methods:Randomized controlled trials (RCTs) on the application of MLD for lymphedema after breast cancer surgery were retrieved from PubMed, Embase, Web of Science, CNKI, and Wanfang databases. The search covered studies published in English and Chinese from January 1, 2000 to February 1, 2024. Literature management and screening were conducted using EndNote X9 software based on inclusion and exclusion criteria. Relevant data from the final included studies for the meta-analysis were extracted. The outcome measures included the incidence of BCRL, reduced values in upper limb volume or circumference in BCRL patients, and the incidence of axillary web syndrome (AWS). Meta-analysis was performed using RevMan 5.4 software. The incidence of BCRL and AWS was expressed as relative risk ( RR) with 95% confidence intervals ( CI), and the Mantel-Haenszel method was used to calculate pooled effect sizes. For the reduction in limb volume or circumference in BCRL patients, standard mean difference ( SMD) with 95% CI was used, and the inverse variance method was applied to calculate pooled effect sizes. A P-value of <0.05 was considered statistically significant. The I2statistic was used to assess heterogeneity among studies; a fixed-effect model was applied when I2<50%, and a random-effects model was used when I2≥50%. Results:A total of 760 studies were retrieved, and 12 RCTs involving 2 279 post-breast cancer surgery patients were ultimately included. Among them, 1 132 patients in the control group received conventional treatment or combined compression bandaging, while 1 147 patients in the experimental group received MLD in addition to the control group interventions. Moderate to high heterogeneity was observed among the studies ( I2>50%, P<0.05), and a random-effects model was used for the analysis of all outcome measures between the two groups. The result showed that compared to the control group, the experimental group had a lower incidence of BCRL ( RR=0.35, 95% CI: 0.20-0.64, Z=3.42, P<0.001), the reduction in limb volume or circumference measurements increased( SWD=-1.28, 95% CI: -2.45~-0.10, Z=2.13, P=0.030), and a lower incidence of AWS ( RR=0.20, 95% CI: 0.07-0.55, Z=3.11, P=0.002). Conclusion:MLD can significantly prevent the occurrence of lymphedema and AWS in patients after breast cancer surgery, and for patients who have already developed lymphedema, MLD can also effectively reduces the degree of swelling. However, more high quality clinical studies are still needed for further verification.
