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Effectiveness of modified complex decongestive physiotherapy for preventing lower extremity lymphedema after radical surgery for cervical cancer: a randomized controlled trial
  1. Xia Wang1,
  2. Yan Ding2,
  3. Hui-Yuan Cai3,
  4. Jing You1,
  5. Fang-Qin Fan3,
  6. Zhi-Fang Cai1 and
  7. Pei An1
  1. 1 Department of Gynecologic Oncology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
  2. 2 Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
  3. 3 Department of Lymphedema Rehabilitation Clinic, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
  1. Correspondence to Professor Yan Ding, Department of Nursing, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; jonish{at}vip.sina.com

Abstract

Background There is a lack of evidence in support of any prophylactic measure to prevent secondary lower extremity lymphedema after radical hysterectomy among patients with cervical cancer. This study aimed to determine the effectiveness of modified complex decongestive physiotherapy in reducing the risk of secondary lower extremity lymphedema after radical surgery.

Methods A randomized single-blind clinical trial was conducted in 120 patients with cervical cancer who underwent laparoscopic radical hysterectomy with pelvic lymphadenectomy between January 2016 and April 2017 in the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Participants were randomly assigned to a modified complex decongestive physiotherapy intervention group (n=60) or control group (n=60). The intervention group received a modified complex decongestive physiotherapy program, which included manual lymph drainage, compression hosiery, regular exercise, and health education. The control group only received a health education program. The main outcome was the incidence of secondary lower extremity lymphedema.

Results A total of 117 patients with cervical cancer completed a 1-year follow-up. Twenty-eight (23.9%) patients developed secondary lower extremity lymphedema (20 (34.5%) patients in the control group and 8 (13.6%) in the intervention group). The incidence of secondary lower extremity lymphedema was significantly higher in the control group than in the intervention group (p=0.008; OR 0.30 (95% CI 0.12 to 0.75). The median percentage of excess volume was significantly less in the intervention group (2.1%, IQR 0.5–3.4%) than in the control group (2.96%, IQR 1.1–4.98%); (p=0.042). The mean (SD) onset time of lymphedema was 8 (2.00) months vs 4.6 (2.82) months in the intervention and control groups, respectively (p=0.004).

Conclusions This randomized trial showed that modified complex decongestive physiotherapy is effective for preventing lower extremity lymphedema in patients with cervical cancer after laparoscopic radical hysterectomy with pelvic lymphadenectomy.

  • cervical cancer
  • postoperative complications
  • lymphatic system
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Footnotes

  • Contributors Study concept and design: YD, XW, H-YC, JY, F-QF, Z-FC, PA. Study implementation and data collection: XW, H-YC, JY, F-QF, Z-FC. Data analysis and interpretation: XW, H-YC. Drafting of manuscript: XW. Review or revision of the manuscript: YD, XW, H-YC, JY, F-QF, Z-FC, PA. Study supervision: YD.

  • Funding This study was sponsored by Shanghai Municipal Commission of Health and Family Planning, key developing disciplines (Grant No 2015ZB0303) and Fudan University Nursing Research Grant (Grant No FNF201417).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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