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Dedicated to improving the treatment of venous disease
Volume 8, Number 04
www.venousdigest.com
April 2001
Copyright 1995 John J. Bergan, MD, Inc.
1 of 7
Venous Digest, 2329 Barley Drive, Vista, CA 92083 USA (760) 599-9725
TREATMENT OF BREAST-CANCER-
RELATED LYMPHEDEMA WITH OR
WITHOUT MANUAL LYMPHATIC
DRAINAGE
Andersen L, Hojis I, Erlandsen M, Andersen J.
Acta Oncologica 2000; 39:399-405
ABSTRACT AND COMMENTARY BY:
Peter S. Mortimer, MD, FRCP
St. George's Hospital Medical School
London, United Kingdom
This is a prospective, randomized study done to investigate
whether or not the addition of manual lymphatic drainage
(MLD) to standard therapy could improve treatment outcome in
women with lymphedema of the ipsilateral arm after breast
cancer treatment. A total of 42 patients were randomly assigned
to standard therapy or standard therapy plus MLD eight times in
a two-week period together with training in self-massage.
Standard therapy included compression garment, exercises,
education in lymphedema, and skin care. After a 12-month
followup period, the authors concluded that both groups had a
significant reduction in edema but that MDL did not contribute
significantly to that reduction.
COMMENTARY
Manual lymphatic drainage (MLD) therapy is an established
component of lymphedema treatment that makes psychological
sense but little evidence exists confirming its efficacy. MLD is
highly desired by patients who perceive great benefit; however,
purchasers of healthcare require proof of cost effectiveness in
order to provide funding. The principle of MLD is simply to
direct lymph into normally draining lymph basins from the
swollen, congested lymphedematous regions where movement
of lymph is largely through collateral routes needing encourage-
ment. MLD is intended to complement other components of
limb lymphedema treatment such as exercise and compression
but it may be the only realistic option for midline lymphedema
such as in the head, neck, body, and breast.
This essentially negative study by Andersen, et al. may please
purchasers of healthcare but not the patients. I have some
reservations that the authors' study design may not have been
sensitive for detection of a significant effect from MLD. For
example, experts recommend that MLD be used for a minimum
TABLE OF CONTENTS
Treatment of Breast-Cancer-Related Lymphedema With or
Without Manual Lymphatic Drainage
Andersen I, Hojis I, Erlandsen M, Andersen J.
Abstracted by: Peter S. Mortimer, United Kingdom
Lymphedema Following Surgery for Breast Cancer
Pain SJ, Purushotham MD.
Liposuction Gives Complete Reduction of Chronic Large Arm
Lymphedema Following Breast Cancer
Brorson H.
Abstracted by: John J. Bergan, MD, California
Edema Volume, Not Timing, is the Key to Success in
Lymphedema Treatment
Ramos SM, O’Donnell LS, Knight G.
Abstracted by: Zygmunt Mackiewicz, Poland
Lymphedema and Lymphocysts Following Lymphadenectomy
May Be Prevented by Omentoplasty: A Pilot Study
Logmans A, Kruyt RH, DeBruin HG, et. al.
Abstracted by: Ermenegildo Enrici, Argentina
Atlas of the Lymphatics of the Lower Limbs (Book Review)
Olszewski WL.
Book reviewed by: John J. Bergan, MD, California
The Origin of the Dispute Over the Discovery of Heparin
Marcum JA.
Abstracted by: Warner P. Bundens, MD, California
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