Manuele lymfedrainage ter preventie van armlymfoedeem na okselkliertoilet bij borstkanker*

Objective

To evaluate the effect of the addition of manual lymph drainage to a treatment programme comprised of guidelines and exercise therapy for the prevention of arm lymphoedema after axillary dissection for breast cancer.

Design

Single-blinded RCT.

Method

We included 160 breast cancer patients who had undergone a unilateral axillary dissection in the period of October 2007-February 2009. Immediately following the operation, patients from the intervention group (n = 79) received postoperative guidelines and engaged in exercise therapy and manual lymph drainage for 6 months. The control group-patients (n = 81) received guidelines and underwent exercise therapy only. The arm volume, arm circumference and body weight of all these patients were measured before the axillary dissection and 1, 3, 6 and 12 months after surgery. Their subjective perceptions of arm lymphoedema and health-related quality of life were also recorded. The primary outcome parameter was the incidence of postoperative arm lymphoedema, defined as an arm-volume-difference increase of 200 ml or more between the operated and healthy side, compared with the preoperative difference. This study has been registered in the Netherlands Trial Register (NTR1055).

Results

Four patients in the intervention group and 2 patients in the control group were lost to follow-up. Twelve months after axillary dissection, the incidence of arm lymphoedema was comparable between the intervention and control group: 24 versus 19% (odds ratio: 1.3; 95% CI: 0.6-2.9; p = 0.45). The incidence was comparable between both groups at earlier time points as well.

Conclusion

We could not prove that manual lymph drainage after axillary dissection for breast cancer in addition to guidelines and exercise therapy has any additional short-term effect on the prevention of arm lymphoedema. It is important to inform patients about this.

Conflict of interest: none declared. Financial support: all authors received a grant from the Flemish Agency for Innovation by Science and Technology.