Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials

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.

Assessment of Risk Factors in Patients who presented to the Outpatient Clinic for Breast Cancer-Related Lymphedema

“…The most important component of CDT phase 1 treatment is short-stretch compression bandaging. Several studies showed that efficient and effective results could be obtained in mild and moderate lymphedema without MLD component (22,24,25). In our study, 14 patients were treated with phase 1 components including education, skin care, exercise, and daily multi-layer short-stretch compression bandaging.…”

Terapia complexa descongestiva no tratamento intensivo do linfedema: revisão sistemática

“…It manifests as a chronic edema, causing discomfort, loss of function, deformity and fatigue 3,4 . Psychological changes are also observed and negatively affect body image and self-esteem 5 .…”

“…The International Society of Lymphology 6,7 supports the use of CDT, which involves a two-stage treatment program: intensive and maintenance care. Intensive treatment allows a substantial reduction in the volume of lymphedema 3,14 and includes four components: manual lymphatic drainage, skin and nail care, compression bandaging and therapeutic exercises 15,16 . Considering CDT for the postoperative lymphedema treatment of breast cancer, there is a need to assess the evidence of this technique.…”

Diabetic foot ulcers in conjunction with lower limb lymphedema: pathophysiology and treatment procedures

“…62 Conversely, a recent systematic review of the RCTs evaluating the effects of MLD on breast cancer-related secondary lymphedema indicates that MLD does not prevent or treat lymphedema. 63 However, there were clinical and statistical inconsistencies between the various studies, confounding the evaluation of the reviewed studies. 63 Compression therapy has been advocated for the management of lymphedema and in the management of high perfusion microangiopathy in patients with DFU.…”

“…63 However, there were clinical and statistical inconsistencies between the various studies, confounding the evaluation of the reviewed studies. 63 Compression therapy has been advocated for the management of lymphedema and in the management of high perfusion microangiopathy in patients with DFU. Compression therapy with elastic stockings reduces capillary leakage and formation of edema, and may retard the progression of diabetic microangiopathy.…”