Intermittent pneumatic compression devices for the prevention and treatment of breast cancer-related lymphedema—a systematic review and meta-analysis

Aims This systematic review and meta-analysis aims to provide an up-to-date assessment of the efficacy of intermittent pneumatic compression (IPC) devices in preventing and treating breast cancer-related lymphedema (BCRL). Methods From establishment to 2025–03-21, randomized controlled trials of IPC in the prevention and treatment of BCRL were searched and included in the databases of PubMed, Embase, Web of Science, The Cochrane Library, CNKI, WanFang Data Knowledge Service (WanFang), and SinoMed. Two researchers used inclusion and exclusion criteria to choose literature and assess its quality. RevMan 5.4 software was used for meta-analysis. Results We found 14 randomized controlled studies with 1397 patients after conducting a thorough search across several databases. Meta-analysis showed that IPC significantly reduced the incidence of BCRL after breast cancer surgery ( P < 0.01, RR = 0.36, 95%CI = [0.22, 0.58]) and improved the extension function of the affected limb ( P = 0.02, SMD = 2.77, 95%CI = [0.41, 5.12]). Subgroup analyses indicated that lymphedema duration ≤ 24 months, IPC pressure ≤ 40 mmHg, treatment time > 2 weeks, and evaluation time ≤ 2 months were associated with better limb volume outcomes (all P < 0.05). However, no significant effects were observed on other joint movements or the patient’s subjective symptoms. Conclusion IPC devices can effectively prevent the occurrence of BCRL, likely due to enhanced lymphatic return and reduced interstitial fluid accumulation, and early IPC intervention (≤ 40 mmHg pressure, > 2-week duration) is recommended for prevention, while combined therapies may be needed for established lymphedema. However, its limited therapeutic efficacy in chronic lymphedema may be related to irreversible structural damage in advanced cases. We need further rigorous, multicenter studies to optimize IPC protocols and clarify its role in BCRL management. Trial registration PROSPERO has registered this study under the CRD42025631301.