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


METHODS
We 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.


RESULTS
In 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).


CONCLUSIONS
The 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.
Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan. kelvintam@h.tmu.edu.tw.
Tsai-Wei
TW
Huang
Sung-Hui
SH
Tseng
Chia-Chin
CC
Lin
Chyi-Huey
CH
Bai
Ching-Shyang
CS
Chen
Chin-Sheng
CS
Hung
Chih-Hsiung
CH
Wu
Ka-Wai
KW
Tam
D005260:Female; D006801:Humans; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery; D004322:Drainage / Q000379:methods; D008209:Lymphedema / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic