EFFICACY OF CONSERVATIVE INTERVENTIONS IN REDUCING THE INCIDENCE OF LOWER LIMB LYMPHEDEMA IN HIGH-RISK WOMEN AFTER GYNECOLOGICAL CANCER
Gynecologic Neoplasms; Lymphedema; Rehabilitation; Meta-Analysis.
Gynecological cancer is an important public health problem, and its treatment may involve surgery, lymph node management, radiotherapy, and chemotherapy. These therapeutic modalities are associated with several adverse effects, including lower limb lymphedema, characterized by the accumulation of protein-rich fluid in the interstitial space, accompanied by increased limb volume and tissue changes. Although lymphedema treatment is well established, its chronic nature and the need for continuous management reinforce the importance of preventive strategies. However, evidence regarding the prevention of gynecological cancer-related lymphedema remains limited. The aim of this systematic review and meta analysis was to evaluate the effectiveness of conservative and non pharmacological interventions for preventing lower limb lymphedema in women undergoing surgical treatment for gynecological cancer. Searches were conducted in the Cochrane, ClinicalTrials, LILACS, PubMed, CINAHL, and PEDro databases, with no language or publication date restrictions. Randomized clinical trials evaluating conservative interventions for lymphedema prevention in adult women with gynecological cancer undergoing surgical treatment associated with lymph node management were included. Study selection and data extraction were performed independently by two researchers. Risk of bias was assessed using the ROB II tool. The certainty of evidence was evaluated using the GRADE approach. A total of 456 records were identified, and five randomized clinical trials, comprising 613 participants, were included. The interventions evaluated included complex decongestive therapy (CDT), resistance exercises, and compression stockings. The meta-analysis demonstrated a favorable effect of conservative interventions, with a significant reduction in the odds of developing lower limb lymphedema compared with the control group (OR = 0.32; 95% CI: 0.14– 0.74; p = 0.003), although high heterogeneity was observed (I² = 74%). CDT significantly reduced the odds of developing lower limb lymphedema compared with the control group (OR = 0.34; 95% CI: 0.17–0.65; p = 0.001), with no evidence of heterogeneity among the included studies (I² = 0%). The results suggest that conservative interventions may contribute to the prevention of lower limb lymphedema following surgical treatment for gynecological cancer, particularly complex decongestive therapy. However, the limited number of studies, methodological limitations, and heterogeneity among intervention protocols restrict confidence in the findings and reinforce the need for randomized clinical trials with greater methodological rigor and longer follow-up periods.