UNASSIGNED: We conducted a systematic search of electronic databases on 18 June 2023, including Medline, Embase, Cochrane Library, Google Scholar, and ClinicalTrials.org. Eligible studies were randomized controlled trials, non-randomized comparative studies, and observational studies that assessed the outcomes of LVA, VLNT, or liposuction in managing BCRL. The primary results of interest were changes in arm volume, lymphatic flow, and quality of life. Two independent reviewers performed the study selection and data extraction. Following this, we systematically reviewed and conducted a risk of bias assessment. Results were qualitatively presented, and a treatment algorithm was developed based on the available data.
UNASSIGNED: We identified 16,593 papers, after removal of duplicates. Following assessment of studies, 73 articles met the inclusion criteria, including 2,373 patients. We were not able to conduct a meta-analysis due to considerable heterogeneity in the methodologies and outcome measures across the studies. Liposuction appears effective for patients presenting with non-pitting lymphedema. LVA indicates variable success rate, with some evidence indicating a reduction in limb volume and symptomatic relief amongst early stages of lymphedema. VLNT showed promising results for limb volume reduction and symptom improvement in patients presenting with mild and moderate lymphedema.
UNASSIGNED: Liposuction, LVA, and VLNT seem to be effective treatments for BCRL, when targeted for the appropriate patient. Well-conducted high evidence clinical studies in the field are still lacking to uncover the efficacy of surgical treatment for BCRL.
■我们于2023年6月18日对电子数据库进行了系统搜索,包括Medline,Embase,科克伦图书馆,谷歌学者,和ClinicalTrials.org。符合条件的研究是随机对照试验,非随机对照研究,以及评估LVA结果的观察性研究,VLNT,或吸脂术管理BCRL。感兴趣的主要结果是手臂体积的变化,淋巴流动,和生活质量。两名独立的审阅者进行了研究选择和数据提取。在此之后,我们系统回顾并进行了偏倚风险评估.结果被定性地呈现,并根据现有数据开发了治疗算法。
■我们确定了16,593篇论文,删除重复项之后。在评估研究之后,73篇文章符合纳入标准,包括2373名患者。我们无法进行荟萃分析,因为研究中的方法和结果指标存在相当大的异质性。吸脂术对表现为非麻点性淋巴水肿的患者似乎有效。LVA表示可变成功率,一些证据表明,在淋巴水肿的早期阶段,肢体体积减少和症状缓解。VLNT在轻度和中度淋巴水肿患者的肢体体积减少和症状改善方面显示出令人鼓舞的结果。
■吸脂,LVA,VLNT似乎是BCRL的有效治疗方法,当针对合适的患者时。在该领域进行良好的高证据临床研究仍然缺乏揭示BCRL手术治疗的功效。