Manual Lymphatic Drainage for Breast Cancer-related Lymphedema: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background The purpose of this systematic review was to meta-analyze the effectiveness of manual lymphatic drainage (MLD) in breast cancer-related lymphedema (BCRL) patients. Methods The following databases: the Cochrane Library, the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Web of Science, ClinicalTrials.gov were systematically searched. All English publications before April 2021 have been retrieved without any restrictions of countries, time, or article type. We included randomized controlled trials (RCTs) examining the effectiveness of MLD versus control group without MLD of women with BCRL. The outcomes were (1) the incidence of lymphedema, (2) volumetric changes of lymphedema, (3) pain, (4) quality of life. Review Manager 5.3 was used to perform statistical analysis. Results In total, 11 RCTs involving 1564 patients were included, in which 10 trials were deemed viable for inclusion in the meta-analysis. Due to the effects of MLD for BCRL, statistically significant improvements were found on the incidence of lymphedema (RR = 0.58, 95% CI [0.37, 0.93], P =.02) and pain intensity (SMD = -0.72, 95% CI [-1.34, -0.09], P = .02). Besides, the meta-analysis carried out implied that the effects that MLD had on volumetric changes of lymphedema and quality of life, were not statistically significant. Conclusion The current evidence based on the RCTs shows that pain of BCRL patients undergoing MLD is significantly improved, while our findings do not support the use of MLD in improving volumetric of lymphedema and quality of life. Note that the effect of MLD for preventing BCRL is worthy of discussion.