Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Dec 4;99(49):e23192.
doi: 10.1097/MD.0000000000023192.

Manual lymphatic drainage for lymphedema in patients after breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials

Mining Liang  1   2   3   4 , Qiongni Chen  1   2   3   4 , Kanglin Peng  1 , Lu Deng  1 , Li He  1   2   3   4 , Yongchao Hou  5 , Yang Zhang  6 , Jincai Guo  7 , Zubing Mei  8 , Lezhi Li  1   9
Affiliations
Meta-Analysis

Manual lymphatic drainage for lymphedema in patients after breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials

Mining Liang et al. Medicine (Baltimore). .

Abstract

Background: Studies have shown that manual lymphatic drainage (MLD) has a beneficial effect on lymphedema related to breast cancer surgery. However, whether MLD reduces the risk of lymphedema is still debated. The purpose of this systematic review and meta-analysis was to summarize the current evidence to assess the effectiveness of MLD in preventing and treating lymphedema in patients after breast cancer surgery.

Methods: From inception to May 2019, PubMed, EMBASE, and Cochrane Library databases were systematically searched without language restriction. We included randomized controlled trials (RCTs) that compared the treatment and prevention effect of MLD with a control group on lymphedema in breast cancer patients. A random-effects model was used for all analyses.

Results: A total of 17 RCTs involving 1911 patients were included. A meta-analysis of 8 RCTs, including 338 patients, revealed that MLD did not significantly reduce lymphedema compared with the control group (standardized mean difference (SMD): -0.09, 95% confidence interval (CI): [-0.85 to 0.67]). Subgroup analysis was basically consistent with the main analysis according to the research region, the publication year, the sample size, the type of surgery, the statistical analysis method, the mean age, and the intervention time. However, we found that MLD could significantly reduce lymphedema in patients under the age of 60 years (SMD: -1.77, 95% CI: [-2.23 to -1.31]) and an intervention time of 1 month (SMD: -1.77, 95% CI: [-2.23 to -1.30]). Meanwhile, 4 RCTs including, 1364 patients, revealed that MLD could not significantly prevent the risk of lymphedema (risk ratio (RR): 0.61, 95% CI: [0.29-1.26]) for patients having breast cancer surgery.

Conclusions: Overall, this meta-analysis of 12 RCTs showed that MLD cannot significantly reduce or prevent lymphedema in patients after breast cancer surgery. However, well-designed RCTs with a larger sample size are required, especially in patients under the age of 60 years or an intervention time of 1 month.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Forest plot for meta-analysis of the pooled SMDs of MLD treatment on post-mastectomy lymphedema in 8 RCTs.
Figure 2
Figure 2
Funnel plot of the effect of MLD on the reduction of post-mastectomy lymphedema in 8 RCTs.
Figure 3
Figure 3
Duval's nonparametric trim and fill procedure for the effect of MLD on the reduction of post-mastectomy lymphedema in 8 RCTs.
Figure 4
Figure 4
Sensitivity analysis for association between MLD use and the reduction of post-mastectomy lymphedema based on 8 RCTs.
Figure 5
Figure 5
Forest plot for meta-analysis of the pooled RRs of MLD on risk of post-mastectomy lymphedema in 4 RCTs.
Figure 6
Figure 6
Sensitivity analysis for association between MLD use and risk of post-mastectomy lymphedema based on 4 RCTs.
See this image and copyright information in PMC

References

    1. Ezzo J, Manheimer E, McNeely ML, et al. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Sys Rev 2015;(5):CD003475. - PMC - PubMed
    1. Zou L, Liu F-H, Shen P-P, et al. The incidence and risk factors of related lymphedema for breast cancer survivors post-operation: a 2-year follow-up prospective cohort study. Breast Cancer (Tokyo, Japan) 2018;25:309–14. - PubMed
    1. Ribeiro Pereira ACP, Koifman RJ, Bergmann A, et al. Incidence and risk factors of lymphedema after breast cancer treatment: 10 years of follow-up. Breast (Edinburgh, Scotland) 2017;36:67–73. - PubMed
    1. Fu MR, Ridner SH, Hu SH, et al. Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011. Psycho-Oncology 2013;22:1466–84. - PMC - PubMed
    1. Kasseroller RE. The Vodder school: the Vodder method. Cancer 1998;83: Suppl.: 2840–2. - PubMed