Comparison of intermittent pneumatic compression pump as adjunct to decongestive lymphatic therapy against decongestive therapy alone for upper limb lymphedema after breast cancer surgery: A systematic review and meta-analysis

Breast Care Pub Date : 2024-04-22 DOI:10.1159/000538940

Min Yao, Puchao Peng, X. Ding, Qinfang Sun, Lijie Chen

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Abstract

Background: Breast cancer is among the most prevalent malignancies in women worldwide, with substantial morbidity and mortality. Upper limb lymphedema (ULL) is a common complication after breast cancer surgery that affects patients' daily activities and quality of life. Decongestive lymphatic therapy (DLT) and intermittent pneumatic compression (IPC) therapy are two primary treatment methods for ULL. Objectives: This study aims to compare the efficacy of DLT with IPC versus DLT alone in the management of ULL following breast cancer surgery. Method: PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane trial registry, Google Scholar, and Clinicaltrials.gov databases were comprehensively searched for randomized controlled trials (RCTs) comparing DLT with IPC and DLT alone in patients with breast cancer-related ULL. Risk of bias was evaluated using the RoB 2 tool. Pooled effect sizes were calculated using random-effects models. Results: A total of 1894 citations were identified by the systematic search. Of them, 9 RCTs were included in the analysis. The pooled SMD for percentage volume reduction was 0.63 (95%CI: -0.24 to 1.50; I2=90.9%), showing no significant difference between the DLT alone and DLT combined with IPC (p=0.15). Pain and heaviness scores were also comparable between the groups. However, there was a significant difference in external rotation joint mobility (SMD=0.62; 95%CI: 0.08-1.16; I2=23.8%), favouring DLT with IPC. Conclusions: Our findings suggest that DLT with IPC and DLT alone showed similar findings in managing ULL after breast cancer surgery, with DLT with IPC showing a greater impact on external rotation joint mobility. Healthcare providers should consider patient preferences and individual factors when selecting the most appropriate treatment modality for ULL management.

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乳腺癌术后上肢淋巴水肿的间歇性气动压缩泵辅助减充血淋巴疗法与单纯减充血疗法的比较：系统回顾和荟萃分析

背景：乳腺癌是全球妇女最常见的恶性肿瘤之一，发病率和死亡率都很高。上肢淋巴水肿（ULL）是乳腺癌手术后常见的并发症，影响患者的日常活动和生活质量。消除充血淋巴疗法（DLT）和间歇性气压疗法（IPC）是治疗上肢淋巴水肿的两种主要方法。研究目的本研究旨在比较 DLT 配合 IPC 与单用 DLT 治疗乳腺癌术后 ULL 的疗效。研究方法在 PubMed Central、SCOPUS、EMBASE、MEDLINE、Cochrane 试验登记、Google Scholar 和 Clinicaltrials.gov 数据库中全面检索了在乳腺癌相关 ULL 患者中比较 DLT 与 IPC 和单纯 DLT 的随机对照试验 (RCT)。使用 RoB 2 工具评估了偏倚风险。使用随机效应模型计算汇总效应大小。结果：系统检索共发现 1894 篇引文。其中有 9 项研究纳入分析。体积缩小百分比的汇总 SMD 为 0.63（95%CI：-0.24 至 1.50；I2=90.9%），显示单纯 DLT 与 DLT 联合 IPC 之间无显著差异（P=0.15）。两组患者的疼痛和沉重感评分也相当。然而，外旋关节活动度存在显著差异（SMD=0.62；95%CI：0.08-1.16；I2=23.8%），DLT 联合 IPC 更受青睐。结论我们的研究结果表明，在管理乳腺癌术后ULL方面，DLT联合IPC与单纯DLT显示出相似的结果，而DLT联合IPC对外旋关节活动度的影响更大。医疗服务提供者在选择最合适的 ULL 治疗方式时，应考虑患者的偏好和个体因素。

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Breast Care

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