Abstract:

Objective

This study combines pairwise Meta-analysis and network Meta-analysis to evaluate the efficacy of different acupuncture therapies in treating postoperative upper limb lymphedema（BCRL） after breast cancer surgery and to assess the optimal acupoint selection strategies.

Methods

A comprehensive literature search was conducted across multiple databases，including CNKI，Wanfang，VIP，ChiCTR，Web of Science，Cochrane Central Register of Controlled Trials （CENTRAL），Embase，PubMed，and Mednar，covering studies published up to May 31，2024. Randomized controlled trials（RCTs） investigating acupuncture interventions for BCRL were included. Two independent reviewers screened the literature，extracted data，and assessed the risk of bias. Data analysis was performed using RevMan 5.3 and Stata 15.0.

Results

A total of 1624 articles were identified and 9 RCTs with a combined sample size of 452 participants were included.Meta-analysis revealed that manual acupuncture alone showed no significant difference in reducing arm circumference of the affected limb at the upper 10 cm of the elbow when compared with the control group ［MD＝-1.3，95% CI （-2.71，0.10）， P＝0.07］. Similarly，no significant difference was observed in wrist circumference reduction between the warm acupuncture or force-dynamic acupuncture groups and the blank control group ［MD ＝-0.13，95% CI （0.37，0.11）， P ＝0.09］. Furthermore，warm acupuncture did not demonstrate a statistically significant reduction in the difference between wrist circumference and the circumference 5 cm above the wrist compared to the blank control group ［MD＝0.07，95% CI （-0.29，0.43），P＝0.35］. However，warm acupuncture showed a significant advantage over diosmin tablets in improving the lymphatic edema index ［MD ＝27.63，95% CI （24.73，30.52）， P＜0.001］. Network Meta-analysis results indicated that among different acupoint selection strategies，distal-proximal acupoint combination exhibited the highest cumulative probability of effectiveness （83.3%），followed by waiting treatment （66.9%），drug therapy（48.8%），and local acupoint selection （1.0%）.

Conclusion

Warm acupuncture is effective in alleviating BCRL symptoms，and the distal-proximal acupoint combination is recommended as the preferred acupoint selection strategy. However，due to the limited number and variable quality of the included literature，further high-quality RCTs are needed to confirm these findings.

Key words: Breast cancer lymphedema, Acupuncture moxibustion therapy, Meta-analysis, Network Meta-analysis