Efficacy of physical therapy for prevention and treatment of postoperative lymphedema in breast cancer: a systematic review and meta-analysis

Background Lymphedema represents a prevalent complication following breast cancer surgery, for which effective interventions can significantly reduce incidence rates. Aims This systematic review and meta-analysis explored the clinical efficacy of different physical therapy interventions on breast cancer-related lymphedema (BCRL) in postoperative patients with breast cancer (BC). Methods Comprehensive literature searches were conducted in eight databases: PubMed, Web of Science, Cochrane Library, ScienceDirect, ClinicalTrials.gov, CINAHL, Embase, and Scopus, from their inception until May 31, 2025. After study selection, meta-analyses were performed using Review Manager software (version 5.4). The primary outcome measures were the overall incidence of BCRL, the incidence of BCRL following specific physical interventions, and the incidence of BCRL after different intervention durations. Results The initial search yielded 3566 publications. 31 studies were included after screening, comprising a total sample size of 4323 patients. Meta-analysis showed that physical intervention had no significant therapeutic (RR = 0.81, 95%CI 0.52 to 1.27, P >0.05) and preventive (RR = 0.72, 95%CI 0.50 to 1.02, P >0.05) effect on BCRL. Subgroup analyses further indicated that compared with 2-month, 3-month, 6-month,and 18-month intervention durations, physical intervention has a significant effect on BCRL. when administered for durations of 12 months (RR = 0.53, 95% CI 0.29 to 0.95, P < 0.05). Conclusion Whether physical intervention is effective in the prevention and treatment of postoperative lymphedema in BC patients’ needs to be further explored, but there is a significant effect in the 12-month intervention subgroup. Therefore, we should pay more attention to the effect of physical intervention measures after enough time in clinical practice. The review protocol was registered prospectively in PROSPERO (Registration number: CRD42024615513). Systemetic Review Registration https://www.crd.york.ac.uk/PROSPERO/myprospero , identifier CRD42024615513.