Abstract
BackgroundLymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD) could prevent or manage limb edema in women after breast-cancer surgery.MethodsWe performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro), SCOPUS, and Cochrane Central Register of Controlled Trials electronic databases were searched for articles on MLD published before December 2012, with no language restrictions. The primary outcome for prevention was the incidence of postoperative lymphedema. The outcome for management of lymphedema was a reduction in edema volume.ResultsIn total, 10 RCTs with 566 patients were identified. Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI) of 0.14 to 2.82. Seven studies assessed the reduction in arm volume, and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI, −9.34 to 159.58).ConclusionsThe current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema.
Highlights
Lymphedema is a common complication of axillary dissection for breast cancer
Selection criteria We reviewed randomized controlled trial (RCT) or quasi-RCTs from the literature that evaluated the outcome of manual lymphatic drainage (MLD) in preventing and treating breast-cancer-related lymphedema
Our analysis showed that there were no significant differences between the two treatment groups, and that significant heterogeneity in the reductions in arm volume occurred between the trials (Figure 3)
Summary
Lymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD) could prevent or manage limb edema in women after breast-cancer surgery. Lymphedema is defined as persistent tissue swelling caused by the blockage or absence of lymph drainage [1]. Lymphedema is a major concern for patients undergoing axillary lymph-node dissection for the treatment of breast cancer. The incidence of lymphedema at 12 months after breast surgery ranges from 12% to 26% [2,3]. Previous surgical techniques for the treatment of lymphedema aimed to reduce limb volume using a debulking resection approach. With the advent of microsurgery, use of multiple lymphatic-venous anastomoses has become the most common surgical treatment [6]. Most patients with lymphedema choose non-surgical treatments, such as the use of elastic stockings, especially in early stages of lymphedema [7]
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