Quality‐of‐life outcomes after operative management of primary and secondary lymphoedema: a systematic review

Abstract

Background Lymphoedema is an incurable and progressive disease that affects not only physical function but overall quality of life. Surgical treatment options for the management of lymphoedema are being increasingly performed. This study aims to review post‐operative health‐related quality of life (HRQOL) following surgical treatment of lymphoedema. Methods A systematic search of the PubMed and Medline databases was performed from the date of their inception until September 2018 to evaluate HRQOL following different surgical options for the treatment of lymphoedema. Results One hundred and thirteen articles were identified. Twenty‐one articles were included in the final review, comprising a total of 736 patients. HRQOL improvements appear to be sustained for at least 6–12 months post‐operatively. In particular, major benefits were noted in the domains based around physical functioning. Patient satisfaction similarly mirrors HRQOL improvements, following an initial dip in the immediate post‐operative period. Conclusion All surgical treatment modalities for the management of lymphoedema confer significant HRQOL improvements across a diverse range of health domains, with this critical outcome of surgery an important pre‐operative consideration. Recommendations for ongoing research are suggested.

Liposuction for Lymphedema

“…Of these potentially relevant articles, 9 publications were excluded for various reasons, and 5 publications met the inclusion criteria and were included in this report. These comprised 3 SRs, [16][17][18] 1 nonrandomized study, 19 and 1 evidence-based guideline. 20 One of the included SRs, (by Chang et al) 16 also provided some additional evidence-based recommendations.…”

“…The methodology of the SR and evidence-based guideline were also critically appraised separately. Thus, evidence from 3 SRs [16][17][18] (1 16 with a meta-analysis [MA] and evidence-based recommendations), 1 nonrandomized study, 19 and 1 evidence-based guideline 20 were summarized in this report.…”

“…Three SRs, [16][17][18] 1 nonrandomized study, 19 and 1 evidence-based guideline 20 were included in this report. All 3 SRs had broader inclusion criteria than the present review.…”

“…All 3 SRs had broader inclusion criteria than the present review. [16][17][18] Several surgical and non-surgical interventions for lymphedema were considered as eligible interventions and comparators. For example, Chang et al 16 considered multiple surgical interventions such as liposuction and VLNT as well as interventions for the prevention of secondary lymphedema.…”

Impact of Activity-Oriented Propioceptive Antiedema Therapy on the Health-Related Quality of Life of Women with Upper-Limb Lymphedema Secondary to Breast Cancer—A Randomized Clinical Trial

“…A task force of the Academy of Physical Therapy Oncology of the American Physical Therapy Association (APTA) developed a clinical practice guideline [ 6 ], recommending with a level A, for stage I education, compression garments and an exercise program, and for stage II, compression bandaging and exercise. Symptom management can be conservative or surgical, HRQoL is often considered in the choice of the therapeutic modality [ 7 , 8 ]. The standard conservative treatment is Complete Decongestive Therapy (CDT) or Combined Physical Therapy (CPT), which consists of a combination of techniques that includes skin care, manual lymphatic drainage, joint mobility exercises, compression garments and multilayer bandages; however, there are no solid data to recommend its universal use due to the characteristics of the treatment itself [ 9 , 10 , 11 ].…”