Huang, T.W., Tseng, S.H., Lin, C.C., Bai, C.H., Chen, C.S., Hung, C.S., … Tam, K.W. (2013). Effects of manual lymphatic drainage on breast cancer-related lymphedema: A systematic review and meta-analysis of randomized controlled trials. World Journal of Surgical Oncology, 11, 1–8.

To examine the evidence on manual lymphatic drainage (MLD) in the prevention or management of limb edema in postsurgical women with breast cancer

• Databases searched were PubMed, EMBASE, CINAHL, SCOPUS, Cochrane Central Register, ClinicalTrials.gov, and PEDro.
• Search keywords were MeSH terms for manual lymph drainage, breast cancer, and lymphedema.
• Studies were included in the review if they were randomized controlled trials or quasi-experimental and evaluated the outcome of MLD for prevention or management of lymphedema. All studies involved patients with breast cancer.
• Studies were excluded from the review if they included patients who did not have axillary lymph node excision or clinical outcomes were not clearly stated.

The literature search retrieved 170 references. Authors independently evaluated methodological quality in terms of blinding, attrition, and use of intention-to-treat analysis. No specific tool for evaluation was described.

• Ten studies were included in the review.
• The total sample size was 536 patients, with a range of 24–158.
• Age ranged from 25–77 years.
• All patients had undergone axillary lymph node excision for breast cancer.

Patients were undergoing multiple phases of care.

Some trials focused on prevention and others involved treatment of lymphedema. Nine studies were included in meta-analysis. Findings showed a risk ratio of 0.063 (95% CI 0.14, 2.83, p = 0.54). High heterogeneity existed. Standard mean difference (SMD) findings showed no benefit of MLD, with SMD = 75.12 (95% CI -9.34, 159.58). Findings showed that the addition of MLD to other individual components of complete rehabilitation such as compression bandaging does not show a significant benefit in reducing arm volume. Overall published reports of MLD show conflicting results. No significant differences were found in the incidence of lymphedema between patients treated with MLD or not.

MLD does not add significant benefit for prevention or management of lymphedema in patients with breast cancer.

• High heterogeneity existed between studies. 
• Several trials were small.
• Only half of the studies reported adequate randomization. 
• In most studies, data collectors were not blinded.

Findings suggest that MLD as an adjunctive treatment is not effective in preventing or managing arm lymphedema in women with breast cancer who have had axillary lymph node excision.