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 2 primary treatment methods for ULL. Objectives: This study aimed 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. The risk of bias was evaluated using the RoB 2 tool. Pooled effect sizes were calculated using random-effects models. Results: A total of 1,894 citations were identified by the systematic search. Of them, 9 RCTs were included in the analysis. The pooled standardized mean difference (SMD) for percentage volume reduction was 0.63 (95% confidence interval [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%), favoring 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.

1.
Łukasiewicz
S
,
Czeczelewski
M
,
Forma
A
,
Baj
J
,
Sitarz
R
,
Stanisławek
A
.
Breast cancer-epidemiology, risk factors, classification, prognostic markers, and current treatment strategies-an updated review
.
Cancers
.
2021
;
13
(
17
):
4287
.
2.
Lovelace
DL
,
McDaniel
LR
,
Golden
D
.
Long-term effects of breast cancer surgery, treatment, and survivor care
.
J Midwifery Wom Health
.
2019
;
64
(
6
):
713
24
.
3.
Fu
MR
.
Breast cancer-related lymphedema: symptoms, diagnosis, risk reduction, and management
.
World J Clin Oncol
.
2014
;
5
(
3
):
241
7
.
4.
Armer
JM
,
Stewart
BR
.
Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60 months
.
Lymphology
.
2010
;
43
(
3
):
118
27
.
5.
Ugur
S
,
Arıcı
C
,
Yaprak
M
,
Mescı
A
,
Arıcı
GA
,
Dolay
K
, et al
.
Risk factors of breast cancer-related lymphedema
.
Lymphat Res Biol
.
2013
;
11
(
2
):
72
5
.
6.
Park
KE
,
Allam
O
,
Chandler
L
,
Mozzafari
MA
,
Ly
C
,
Lu
X
, et al
.
Surgical management of lymphedema: a review of current literature
.
Gland Surg
.
2020
;
9
(
2
):
503
11
.
7.
Ezzo
J
,
Manheimer
E
,
McNeely
ML
,
Howell
DM
,
Weiss
R
,
Johansson
KI
, et al
.
Manual lymphatic drainage for lymphedema following breast cancer treatment
.
Cochrane Database Syst Rev
.
2015
;
2015
(
5
):
CD003475
.
8.
Feldman
JL
,
Stout
NL
,
Wanchai
A
,
Stewart
BR
,
Cormier
JN
,
Armer
JM
.
Intermittent pneumatic compression therapy: a systematic review
.
Lymphology
.
2012
;
45
(
1
):
13
25
.
9.
Johansson
K
,
Lie
E
,
Ekdahl
C
,
Lindfeldt
J
.
A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema
.
Lymphology
.
1998
;
31
(
2
):
56
64
.
10.
Haghighat
S
,
Lotfi-Tokaldany
M
,
Yunesian
M
,
Akbari
ME
,
Nazemi
F
,
Weiss
J
.
Comparing two treatment methods for post mastectomy lymphedema: complex decongestive therapy alone and in combination with intermittent pneumatic compression
.
Lymphology
.
2010
;
43
(
1
):
25
33
.
11.
Gurdal
SO
,
Kostanoglu
A
,
Cavdar
I
,
Ozbas
A
,
Cabioglu
N
,
Ozcinar
B
, et al
.
Comparison of intermittent pneumatic compression with manual lymphatic drainage for treatment of breast cancer-related lymphedema
.
Lymphat Res Biol
.
2012
;
10
(
3
):
129
35
.
12.
Page
MJ
,
McKenzie
JE
,
Bossuyt
PM
,
Boutron
I
,
Hoffmann
TC
,
Mulrow
CD
, et al
.
The PRISMA 2020 statement: an updated guideline for reporting systematic reviews
.
BMJ
.
2021
;
372
:
n71
.
13.
Sterne
JAC
,
Savović
J
,
Page
MJ
,
Elbers
RG
,
Blencowe
NS
,
Boutron
I
, et al
.
RoB 2: a revised tool for assessing risk of bias in randomised trials
.
BMJ
.
2019
;
366
:
l4898
.
14.
Cochrane handbook for systematic reviews of interventions
. [Internet]. [cited 2023 Feb 12]. Available from: https://training.cochrane.org/handbook.
15.
Szuba
A
,
Achalu
R
,
Rockson
SG
.
Decongestive lymphatic therapy for patients with breast carcinoma-associated lymphedema. A randomized, prospective study of a role for adjunctive intermittent pneumatic compression
.
Cancer
.
2002
;
95
(
11
):
2260
7
.
16.
Diab
HA
,
Asham
HN
,
Aboelnour
NH
,
Alagizy
HA
.
Effect of intermittent pneumatic compression in combination with kinesiotape on post mastectomy lymphedema
.
Egypt J Hosp Med
.
2021
;
85
(
1
):
2794
9
.
17.
Uzkeser
H
,
Karatay
S
,
Erdemci
B
,
Koc
M
,
Senel
K
.
Efficacy of manual lymphatic drainage and intermittent pneumatic compression pump use in the treatment of lymphedema after mastectomy: a randomized controlled trial
.
Breast Cancer
.
2015
;
22
(
3
):
300
7
.
18.
Szolnoky
G
,
Lakatos
B
,
Keskeny
T
,
Varga
E
,
Varga
M
,
Dobozy
A
, et al
.
Intermittent pneumatic compression acts synergistically with manual lymphatic drainage in complex decongestive physiotherapy for breast cancer treatment-related lymphedema
.
Lymphology
.
2009
;
42
(
4
):
188
94
.
19.
Tastaban
E
,
Soyder
A
,
Aydin
E
,
Sendur
OF
,
Turan
Y
,
Ture
M
, et al
.
Role of intermittent pneumatic compression in the treatment of breast cancer-related lymphoedema: a randomized controlled trial
.
Clin Rehabil
.
2020
;
34
(
2
):
220
8
.
20.
Sanal-Toprak
C
,
Ozsoy-Unubol
T
,
Bahar-Ozdemir
Y
,
Akyuz
G
.
The efficacy of intermittent pneumatic compression as a substitute for manual lymphatic drainage in complete decongestive therapy in the treatment of breast cancer related lymphedema
.
Lymphology
.
2019
;
52
(
2
):
82
91
.
21.
Shao
Y
,
Qi
K
,
Zhou
Q-H
,
Zhong
D-S
.
Intermittent pneumatic compression pump for breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials
.
Oncol Res Treat
.
2014
;
37
(
4
):
170
4
.
22.
Huang
T-W
,
Tseng
S-H
,
Lin
C-C
,
Bai
C-H
,
Chen
C-S
,
Hung
C-S
, et al
.
Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials
.
World J Surg Oncol
.
2013
;
11
:
15
.
You do not currently have access to this content.