Table 2 Studies reporting lymphedema prevalence or incidence
| Â | Sample size | Stage of Diagnosis | Treatment received | Measurement method | Lymphedema definition | Prevalence or Incidence | Risk factors | Quality of Article |
|---|---|---|---|---|---|---|---|---|
Breast Cancer | ||||||||
 (Yılmaz and Coşkun 2019) [23], Turkey | N = 64 | Stage I-III | Breast cancer surgery | Self-reported and arm circumference | > 1.5 cm difference and lymphedema severity was defined as mild (if the difference between the extremities measurement is less than 3 cm), moderate (3–5 cm) and severe (> 5 cm) | 14/64 (21.9%) | BMI and hand dominance | High risk |
 (Kibar, Dalyan Aras et al. 2017) [25], Turkey | N = 287 | … | Modified Radical Mastectomy or Lumpectomy; Chemotherapy and/or Radiotherapy | Arm circumference | ≥2 cm difference | 119/287 (41.3%) | Axillary radiotherapy and ALND | Low risk |
(Erdogan Iyigun, Selamoglu et al. 2015) [26], Turkey | N = 37 | Stages 0-II | Surgery | Bioimpedance, clinical diagnosis, arm circumference | Impedance ratio > 10 | 8/37 (21.1%) | Age, surgical procedure, tumor localization, systemic treatment, body mass index, and lymphedema | High risk |
(KİBar, Aras et al. 2015) [27], Turkey | N = 190 | … | Level III ALND subsequent to a modified radical mastectomy or lumpectomy together with chemotherapy or radiotherapy | Arm circumference | ≥2 cm difference | 79/190 (41.5%) | Age, BMI, chemotherapy | High risk |
(Ay, Kutun et al. 2014) [28], Turkey | N = 5064 | Stage I & II | Mastectomy | Arm circumference | > 5 cm difference | 1008/5064 (19.9%) | Employment status, Age, BMI, post-operative chemotherapy treatment. Post axillary radiotherapy was not significant | Low risk |
(Ozcinar, Guler et al. 2012) [29], Turkey | N = 221 | Stage I, II, cT1, 2 N0 | Surgery | Arm circumference | > 2 cm difference | 16/221 (7.2%) | Type of the surgical procedure done, RT to regional lymphatics, ALND and RT Administration to axilla | Low risk |
(Ozaslan and Kuru 2004) [30], Turkey | N = 240 | Stage I-III | Surgery | Arm circumference | > 4 cm difference | 68/240 (28%) | Axillary radiotherapy; BMI | Low risk |
(Rebegea, Firescu et al. 2015) [21], Romania | N = 305 | Stages I-IV | Surgery | Arm circumference | ≥2 cm difference | 18/305 (5.9%) | number of lymph nodes removed; stage of the disease; chemotherapy and hormonal therapy | Low risk |
(Borman, Yaman et al. 2018) [51], Brazil | N = 135 | Post breast cancer related with no advanced malignancy | … | Volume measurement | > 10% volume difference | 125/135 (92.5%) | … | High risk |
(Vieira, Silva et al. 2018) [32], Brazil | N = 16 | ECOG scores of 0 to 1 | Radiotherapy | Arm circumference | ≥200 mm difference | 4/16 (25%) | … | High risk |
(Borman, Yaman et al. 2017) [51], Brazil | N = 188 | Subclinical, reversible, spontaneous irreversible, elephantiasis and stages I-III with mean time past after the surgery was 21.5 ± 27.5 months | Surgery | Self-reported arm swelling, arm circumferences | A positive Stemmer’s sign | 170/188 (90%) | Lymphedema awareness | High risk |
(Godoy, Dias et al. 2014) [33], Brazil | N = 1583 | … | Surgery | Self-reported arm LE | Swelling of the arm | 12/1583 (0.8%) suffered LE; 12/32 (37.5%) suffered LE due to axillary dissection | … | High risk |
(Paiva, Rodrigues et al. 2013) [34], Brazil | N = 250 | … | Surgery (more than 6 months) | Perimetry | ≥2 cm difference | 112/250 (44.8%) | ALND; SLNB; time after surgery | Low risk |
(do Nascimento, de Oliveira et al. 2012) [24], Brazil | N = 707 | Stages I-IV (presented with overweight, diabetic, hypertensive and shoulder dysfunction) | Surgery | Self-reported LE and perimetry | Swelling of the arm | 164/707 (23.2%) | … | High risk |
(de Godoy, Barufi et al. 2012) [35], Brazil | N = 35 | … | Breast cancer treatment | Self-reported presence of chest swelling; Bioimpedance | > 100 g difference | 4/35 (11.42%) | … | High risk |
(Campanholi, Duprat et al. 2011) [20], Brazil | N = 84 | … | Surgery | Arm and leg circumference; volume measurement; self-reported | > 10% difference in volume; 0–10% = normal, 10.1–20% = mild, 20.1–40% = moderate, 40.1–80% = marked, > 80.1% = severe in the arms and classified in the leg as 0–6.5% = normal, 6.6–20% = mild, 20.1–40% = moderate and > 40.1% = severe | 7/40 (17.5%) in the arm; 26/44 (59.1%) in the lower limb | Local lymphadenecto-my including axillary, inguinal and ilioinguinal | High risk |
(Bergmann, Bourrus et al. 2011) [36], Brazil | N = 220 | Stages IIA, IIB, IIIA and IIIB | Advanced Breast Cancer Treatment | Self-report, volumetric measurement | > 200 ml difference in volume | 13/220 (6.6%) | Obstruction of lymphatic drainage and clinical stage of the condition; Radiotherapy and chemotherapy and delay in accessing neo-adjuvant therapy | Low risk |
(Velloso, Barra et al. 2011) [37], Brazil | N = 45 | … | Surgery (21.3 months) | Arm circumference | > 10% difference | 2/45 (4.4%) | … | High risk |
(Alem and Gurgel 2008) [38], Brazil | N = 29 | Post-surgery with mean time for breast cancer 86.1 ± 81.6 months. | Breast Cancer Surgery | Arm circumference | ≥2 cm difference; a restriction of 20° or more in flexion and/or abduction in ROM. | 23/29 (79.0%) | … | High risk |
(Paim, Lima et al. 2008) [5], Brazil | N = 96 | … | Surgery | Arm circumference/ perimetry and Clinical diagnosis | > 1 cm and any two of lymphedema symptoms of limb heaviness, swelling, tightness or firmness | 17/96 (17%) and the prevalence with treatment; ALND 14/48 (29.2%) and SLNB 2/48 (4.2%) | ALND; SLNB | Low risk |
(Batiston and Santiago 2005) [39], Brazil | N = 160 | Stage I - IV | Radical surgery (68.8%) and conservative surgery (31.2%) | Self-reported swelling | … | 47/160 (29.2%) | Time after surgery to physiotherapy rehabilitation | High risk |
(Elumelu-Kupoluyi, Adenipekun et al. 2013) [40], Nigeria | N = 63 | Stage II | Radiotherapy | Clinical diagnosis | A positive stemmer’s sign | 55/63 (78%) in the arm. | … | High risk |
(Khanna, Gupta et al. 2019) [41], India | N = 98 | Locally advanced (IIIB) and Early/palpable stage (I-IIIA) | Breast carcinoma treatment; Mastectomy and Wide local incision | Arm circumference | ≥2 cm difference in limb between pre-op and post-op measurements | 23/98 (23.5%) | Drainage of seroma, type of treatment especially axillary radiotherapy and skin necrosis, chemotherapy | Low risk |
(Rastogi, Jain et al. 2018) [42], India | N = 100 | Stages IIA, IIB, IIIA, IIIB and IIIC | Mastectomy, Radiotherapy and Axillary Lymph Node Dissection | Arm circumference | ≥2 cm difference | 13/100 (13.0%) and 13/33 (39.4%) recorded by patients with BMI > 25 | BMI; Number of lymph nodes removed; regional lymph node radiated | High risk |
(Gopal, Acharya et al. 2017) [43], India | N = 199 | Early and locally advanced stages | Radiotherapy, Lymph Node dissection, Surgery and Chemotherapy | Arm circumference | > 5% difference | 85/199 (42.7%) | stage of cancer, BMI, receiving radiotherapy or chemotherapy, number of lymph nodes removed | High risk |
(Nandi, Mahata et al. 2014) [52], India | N = 135 | Grades I-IV | Chemotherapy, Radiotherapy and Mastectomy | Self-reported | … | 9/135 (6.7%) | … | High risk |
(Raja, Damke et al. 2014) [44], India | N = 30 | Stage I and II | Modified Radical Mastectomy with Axillary Clearance | Self-reported | Lymphedema grading system of mild, moderate and severe | 17/30 (56.7%) | … | High risk |
(Deo, Ray et al. 2004) [45], India | N = 299 | Stage I, II & III | Post Breast cancer treatment (Surgery & Radiotherapy) | Arm Circumference | > 3 cm | 100/299 (33%) | Axillary irradiation; comorbidities. | Low risk |
(Halder, Morewya et al. 2001) [46], Papua New Guinea (East Asia) | N = 790 | Stages I-IV | Lumpectomy and Mastectomy | Self-reported | … | 3/790 (0.4%) | … | High risk |
(Haddad, Farzin et al. 2010) [54], Iran | N = 355 | Cases of no evidence of recurrence or metastases after surgery | Surgery | Arm circumference and self-reported swelling | > 10% difference | 63/355 (17.5%) | Type of surgery, treatment with radiotherapy, and prescription of a supraclavicular field of radiation | Low risk |
(Honarvar, Sayar et al. 2016) [47], Iran | N = 683 | … | Modified radical mastectomy, conservative surgery, chemotherapy, radiotherapy and hormone therapy | Arm circumference | ≥2 cm difference and a positive stemmer’s sign | 400/683 (58.6%) | Type of surgery, treatment with radiotherapy, physical activity, modified radical mastectomy, BMI, hormone therapy, size of tumor, and number of excised or affected lymph nodes. | Low risk |
(Morcos, Al Ahmad et al. 2013) [48], Jordan | N = 531 | … | Surgery, chemotherapy and radiotherapy | Arm circumference | ≥2 cm difference | 114/531 (21.4%) | Surgery type received | High risk |
Vulvar Cancer | ||||||||
(de Melo Ferreira, de Figueiredo et al. 2012) [49], Brazil | N = 50 | Stage I-IV | Vulvectomy | Clinical diagnosis, observation and palpation by the clinician | Severity and limb functions considered based on disabilities reported | 28/56 (50%); 17/28 (60.7%) among cases and 3/28 (10.7%) among the control | Severity and BMI | High risk |
(Eke, Alabi-Isama et al. 2010) [53], Nigeria | N = 11 | Stages IB-IV | Vulvar carcinoma surgery | Self-reported LLE | … | 1/11 (9.1%) | … | High risk |
Cervical Cancer | ||||||||
(Marin, Pleşca et al. 2014) [50], Romania | N = 324 | … | Lymphadenohysterocolpectomy; Radical hysterectomy | Self-reported | … | 37/324 (11.4%); lower limb lymphedema (13.5% III vs 11.5% II) | … | High risk |
(Elumelu-Kupoluyi, Adenipekun et al. 2013) [40], Nigeria | N = 63 | Stage II | Radiotherapy | Clinical diagnosis | A positive stemmer’s sign | 8/63 (13%) in the leg | … | High risk |
(Dem, Kasse et al. 2001), Senegal [22] | N = 86 | Stages I-IV | Cervical cancer treatment | Self-reported | … | 6/86 (6.98%) in the leg | … | High risk |