Interventions for Lower Limb Lymphedema Following Gynecological Cancer: A Systematic Review and Meta-Analysis

Purpose To evaluate the effectiveness of interventions for managing lower limb lymphedema (LLL) in women following gynecological cancer treatment. Methods A review of randomized controlled trials and quasi-experimental studies was conducted, covering literature up to November 2024 across six databases: Web of Science, PubMed, Cochrane Library, Medline, CINAHL, and Scopus. Meta-analyses were performed using Stata 17.0 with a random effects model. Results Nine studies (four RCTs and five quasi-experimental) involving 307 participants were included. Risk of bias was generally low, based on RoB 2 and ROBINS-I assessments, though some domains showed high risk. Interventions, exercise, compression therapy, and their combination, yielded improvements in limb volume, pain, and quality of life in several studies. However, meta-analysis found no significant overall effect on limb volume (SMD = 0.07, 95% CI: -0.96 to 1.09, p = 0.90), with high heterogeneity (I² = 96.25%). Meta-regression identified mean age as a significant moderator (p = 0.025). No serious adverse effects were reported, and no publication bias was detected. Conclusions While the meta-analysis did not show a significant reduction in limb volume, the findings support exercise combined with compression therapy as a safe, practical, and potentially effective strategy for managing LLL and its symptoms.