Manual lymphatic drainage for lymphedema in patients after breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 33285693 · doi:10.1097/MD.0000000000023192
What was done
A systematic review and meta-analysis searched PubMed, EMBASE, and the Cochrane Library up to May 2019 without language restrictions. Investigators included randomized controlled trials evaluating manual lymphatic drainage (MLD) compared with control groups for the prevention and treatment of lymphedema after breast cancer surgery. Effect estimates were synthesized using random-effects models.
What was found
Across 17 included RCTs involving 1,911 patients, meta-analysis of 8 RCTs (n = 338) found MLD did not significantly reduce established lymphedema compared to control (SMD: -0.09, 95% CI: -0.85 to 0.67). For prevention, 4 RCTs (n = 1,364) showed MLD did not significantly reduce lymphedema risk (RR: 0.61, 95% CI: 0.29 to 1.26). Subgroup analyses found significant lymphedema reduction only in patients aged under 60 years (SMD: -1.77, 95% CI: -2.23 to -1.31) and when intervention duration was 1 month (SMD: -1.77, 95% CI: -2.23 to -1.30).
Why it matters
These findings suggest that routine manual lymphatic drainage is not broadly effective for treating or preventing breast cancer-related lymphedema.
Limits
The treatment meta-analysis included a small aggregate sample size (338 patients across 8 studies). Subgroup findings for age under 60 and 1-month duration produced nearly identical effect estimates and confidence intervals, suggesting potential overlap. Details regarding control interventions, specific surgical techniques, and long-term functional outcomes were not reported in the abstract.