Effects of acupuncture on breast cancer-related lymphoedema: A systematic review and meta-analysis

Background: Lymphoedema is a common complication of axillary dissection surgery, especially for breast cancer patients. Approximately 20% of breast cancer survivors develop breast cancer-related lymphoedema (BCRL). Acupuncture (AC) has become an alternative treatment for BCRL. In this study, we investigated whether AC was a good method for treating limb oedema in women after breast cancer surgery. Methods: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effectiveness of AC in the prevention of BCRL Searching strategies were performed with the following keywords: "Breast cancer," "Acupuncture," "neoplasm," and "lymphoedema," with derivations and different combinations of these keywords. The following databases were searched: PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, WanFang, and CBM. Studies published in English and Chinese were considered for inclusion in this study. Study selection, risk of bias assessment and data extraction were independently conducted. Statistical analyses were conducted with RevMan software (version 5.3). Results: Eight studies were identified by the search strategy, and 519 patients were included in this study. The effective rate was higher (odds ratios (OR): 4.23; 95% confidence interval (CI): 2.11 to 8.49; Z= 4.07, p < 0.0001) in the experimental group than that in the control group. There were no significant improvements in the front flexion (mean difference (MD): 0.19; 95% CI: -3.68 to 4.06; Z= 0.09, p = 0.92) or the back extension (MD: 0.42; 95% CI: -2.22 to 3.06; Z= 0.31, p = 0.75) movements of the shoulder between the experimental and control groups. Conclusions: AC may be an effective method for improving the condition of breast cancer-related lymphoedema. However, due to the high risk of bias and the low quality of the available studies, further high-quality RCTs are needed to confirm the efficacy of AC for breast cancer-related lymphoedema patients. (C) 2019 Elsevier Inc. All rights reserved.