Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials
Identifieur interne : 002364 ( Pmc/Checkpoint ); précédent : 002363; suivant : 002365Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials
Auteurs : Tsai-Wei Huang [Taïwan] ; Sung-Hui Tseng [Taïwan] ; Chia-Chin Lin [Taïwan] ; Chyi-Huey Bai [Taïwan] ; Ching-Shyang Chen [Taïwan] ; Chin-Sheng Hung [Taïwan] ; Chih-Hsiung Wu [Taïwan] ; Ka-Wai Tam [Taïwan]Source :
- World Journal of Surgical Oncology [ 1477-7819 ] ; 2013.
Abstract
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.
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.
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).
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.
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DOI: 10.1186/1477-7819-11-15
PubMed: 23347817
PubMed Central: 3562193
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wicri:level="1"><nlm:aff id="I1">Department of Nursing, College of Medicine and Nursing, HungKuang University, Taichung City, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Nursing, College of Medicine and Nursing, HungKuang University, Taichung City</wicri:regionArea><wicri:noRegion>Taichung City</wicri:noRegion></affiliation></author><author><name sortKey="Tseng, Sung Hui" sort="Tseng, Sung Hui" uniqKey="Tseng S" first="Sung-Hui" last="Tseng">Sung-Hui Tseng</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Lin, Chia Chin" sort="Lin, Chia Chin" uniqKey="Lin C" first="Chia-Chin" last="Lin">Chia-Chin Lin</name><affiliation wicri:level="1"><nlm:aff id="I3">School of Nursing, Taipei Medical University, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>School of Nursing, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Bai, Chyi Huey" sort="Bai, Chyi Huey" uniqKey="Bai C" first="Chyi-Huey" last="Bai">Chyi-Huey Bai</name><affiliation wicri:level="1"><nlm:aff id="I4">School of Public Health, Taipei Medical University, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>School of Public Health, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Chen, Ching Shyang" sort="Chen, Ching Shyang" uniqKey="Chen C" first="Ching-Shyang" last="Chen">Ching-Shyang Chen</name><affiliation wicri:level="1"><nlm:aff id="I5">Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Hung, Chin Sheng" sort="Hung, Chin Sheng" uniqKey="Hung C" first="Chin-Sheng" last="Hung">Chin-Sheng Hung</name><affiliation wicri:level="1"><nlm:aff id="I5">Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Wu, Chih Hsiung" sort="Wu, Chih Hsiung" uniqKey="Wu C" first="Chih-Hsiung" last="Wu">Chih-Hsiung Wu</name><affiliation wicri:level="1"><nlm:aff id="I6">Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I7">Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Tam, Ka Wai" sort="Tam, Ka Wai" uniqKey="Tam K" first="Ka-Wai" last="Tam">Ka-Wai Tam</name><affiliation wicri:level="1"><nlm:aff id="I5">Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I7">Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I8">Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I9">Center for Evidence-Based Medicine, Taipei Medical University, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Center for Evidence-Based Medicine, Taipei Medical University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author></analytic><series><title level="j">World Journal of Surgical Oncology</title><idno type="eISSN">1477-7819</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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).</p></sec><sec><title>Conclusions</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Stanton, Aw" uniqKey="Stanton A">AW Stanton</name></author><author><name sortKey="Modi, S" uniqKey="Modi S">S Modi</name></author><author><name sortKey="Mellor, Rh" uniqKey="Mellor R">RH Mellor</name></author><author><name sortKey="Levick, Jr" uniqKey="Levick J">JR Levick</name></author><author><name sortKey="Mortimer, Ps" uniqKey="Mortimer P">PS Mortimer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="K Rki, A" uniqKey="K Rki A">A Kärki</name></author><author><name sortKey="Simonen, R" uniqKey="Simonen R">R Simonen</name></author><author><name sortKey="M Lki, E" uniqKey="M Lki E">E Mälkiä</name></author><author><name sortKey="Selfe, J" uniqKey="Selfe J">J 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<front><journal-meta><journal-id journal-id-type="nlm-ta">World J Surg Oncol</journal-id><journal-id journal-id-type="iso-abbrev">World J Surg Oncol</journal-id><journal-title-group><journal-title>World Journal of Surgical Oncology</journal-title></journal-title-group><issn pub-type="epub">1477-7819</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23347817</article-id><article-id pub-id-type="pmc">3562193</article-id><article-id pub-id-type="publisher-id">1477-7819-11-15</article-id><article-id pub-id-type="doi">10.1186/1477-7819-11-15</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials</article-title></title-group><contrib-group><contrib contrib-type="author" id="A1"><name><surname>Huang</surname><given-names>Tsai-Wei</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>m8706001@gmail.com</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Tseng</surname><given-names>Sung-Hui</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>m003089010@tmu.edu.tw</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Lin</surname><given-names>Chia-Chin</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>clin@tmu.edu.tw</email></contrib><contrib contrib-type="author" id="A4"><name><surname>Bai</surname><given-names>Chyi-Huey</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>baich@tmu.edu.tw</email></contrib><contrib contrib-type="author" id="A5"><name><surname>Chen</surname><given-names>Ching-Shyang</given-names></name><xref ref-type="aff" rid="I5">5</xref><email>cs_chen@mail.tmch.org.tw</email></contrib><contrib contrib-type="author" id="A6"><name><surname>Hung</surname><given-names>Chin-Sheng</given-names></name><xref ref-type="aff" rid="I5">5</xref><email>hungcs2000@yahoo.com.tw</email></contrib><contrib contrib-type="author" id="A7"><name><surname>Wu</surname><given-names>Chih-Hsiung</given-names></name><xref ref-type="aff" rid="I6">6</xref><xref ref-type="aff" rid="I7">7</xref><email>chwu@tmu.edu.tw</email></contrib><contrib contrib-type="author" corresp="yes" id="A8"><name><surname>Tam</surname><given-names>Ka-Wai</given-names></name><xref ref-type="aff" rid="I5">5</xref><xref ref-type="aff" rid="I7">7</xref><xref ref-type="aff" rid="I8">8</xref><xref ref-type="aff" rid="I9">9</xref><email>kelvintam@h.tmu.edu.tw</email></contrib></contrib-group><aff id="I1"><label>1</label>Department of Nursing, College of Medicine and Nursing, HungKuang University, Taichung City, Taiwan</aff><aff id="I2"><label>2</label>Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan</aff><aff id="I3"><label>3</label>School of Nursing, Taipei Medical University, Taipei, Taiwan</aff><aff id="I4"><label>4</label>School of Public Health, Taipei Medical University, Taipei, Taiwan</aff><aff id="I5"><label>5</label>Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan</aff><aff id="I6"><label>6</label>Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, Taipei, Taiwan</aff><aff id="I7"><label>7</label>Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan</aff><aff id="I8"><label>8</label>Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan</aff><aff id="I9"><label>9</label>Center for Evidence-Based Medicine, Taipei Medical University, Taipei, Taiwan</aff><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub"><day>24</day><month>1</month><year>2013</year></pub-date><volume>11</volume><fpage>15</fpage><lpage>15</lpage><history><date date-type="received"><day>10</day><month>9</month><year>2012</year></date><date date-type="accepted"><day>6</day><month>1</month><year>2013</year></date></history><permissions><copyright-statement>Copyright ©2013 Huang et al.; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2013</copyright-year><copyright-holder>Huang et al.; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.wjso.com/content/11/1/15"></self-uri><abstract><sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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).</p></sec><sec><title>Conclusions</title><p>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.</p></sec></abstract><kwd-group><kwd>Manual lymph drainage</kwd><kwd>Lymphedema</kwd><kwd>Breast cancer</kwd><kwd>Meta-analysis</kwd></kwd-group></article-meta></front></pmc><affiliations><list><country><li>Taïwan</li></country></list><tree><country name="Taïwan"><noRegion><name sortKey="Huang, Tsai Wei" sort="Huang, Tsai Wei" uniqKey="Huang T" first="Tsai-Wei" last="Huang">Tsai-Wei Huang</name></noRegion><name sortKey="Bai, Chyi Huey" sort="Bai, Chyi Huey" uniqKey="Bai C" first="Chyi-Huey" last="Bai">Chyi-Huey Bai</name><name sortKey="Chen, Ching Shyang" sort="Chen, Ching Shyang" uniqKey="Chen C" first="Ching-Shyang" last="Chen">Ching-Shyang Chen</name><name sortKey="Hung, Chin Sheng" sort="Hung, Chin Sheng" uniqKey="Hung C" first="Chin-Sheng" last="Hung">Chin-Sheng Hung</name><name sortKey="Lin, Chia Chin" sort="Lin, Chia Chin" uniqKey="Lin C" first="Chia-Chin" last="Lin">Chia-Chin Lin</name><name sortKey="Tam, Ka Wai" sort="Tam, Ka Wai" uniqKey="Tam K" first="Ka-Wai" last="Tam">Ka-Wai Tam</name><name sortKey="Tam, Ka Wai" sort="Tam, Ka Wai" uniqKey="Tam K" first="Ka-Wai" last="Tam">Ka-Wai Tam</name><name sortKey="Tam, Ka Wai" sort="Tam, Ka Wai" uniqKey="Tam K" first="Ka-Wai" last="Tam">Ka-Wai Tam</name><name sortKey="Tam, Ka Wai" sort="Tam, Ka Wai" uniqKey="Tam K" first="Ka-Wai" last="Tam">Ka-Wai Tam</name><name sortKey="Tseng, Sung Hui" sort="Tseng, Sung Hui" uniqKey="Tseng S" first="Sung-Hui" last="Tseng">Sung-Hui Tseng</name><name sortKey="Wu, Chih Hsiung" sort="Wu, Chih Hsiung" uniqKey="Wu C" first="Chih-Hsiung" last="Wu">Chih-Hsiung Wu</name><name sortKey="Wu, Chih Hsiung" sort="Wu, Chih Hsiung" uniqKey="Wu C" first="Chih-Hsiung" last="Wu">Chih-Hsiung Wu</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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