Manejo fisioterapéutico versus manejo quirúrgico del linfedema de miembro superior posterior a disección de ganglios linfáticos axilares por cáncer de mama: revisión sistemática

Abstract

Objective: To compare physiotherapeutic and surgical treatments used in the management of upper limb lymphedema following axillary lymph node dissection for breast cancer, evaluating their effectiveness in reducing edema volume, restoring mobility, and improving quality of life. Methodology: A systematic review was conducted of clinical intervention and observational studies published over the past seven years, in any language, that provided relevant information on therapeutic approaches for this condition. Articles were identified in PubMed, Elsevier, and Springer. The search was completed in November 2024. The risk of bias was assessed using the RoB 1 and RoB 2 tools, following the PRISMA 2020 guidelines. Results: Thirteen studies were included, of which 9 were clinical trials and 4 were observational studies, with a total population of 870 patients. The evidence analyzed showed that Complex Decongestive Therapy remains the treatment of choice due to its multimodal approach, safety, and ability to be combined with other conservative interventions. Discussion: The main limitation identified was the scarcity of studies directly comparing physiotherapeutic and surgical treatments. However, the available findings suggest that physiotherapeutic yields better outcomes in reducing arm volume, improving function, and enhancing patients’ perceived well-being. Conclusions: Physiotherapeutic treatment seems to be superior to surgical treatment in this population. However, comparative studies and long-term follow-up are needed to confirm the long-term surgical efficacy. Keywords: arteriovenous anastomosis, arm, manual lymphatic drainage, breast cancer lymphedema