Effect of BMI-stratified management based on the meridian-lymph axis theory on lower extremity lymphedema after gynecological cancer surgery: a randomized controlled trial

Background Lower-extremity lymphedema (LEL) is a chronic complication after gynecological cancer surgery. Obesity may aggravate lymphatic dysfunction and reduce the effectiveness of standard physical management. We evaluated a BMI-stratified integrated intervention informed by a meridian-lymph conceptual framework. Methods A total of 60 patients with gynecological cancer-related LEL were randomly assigned in a 1:1 ratio to an intervention group (n=30) or a control group (n=30). The intervention group received BMI-stratified meridian massage and dietary and health guidance for 6 months, whereas the control group received compression stockings, health education, and aerobic exercise. Patients were divided into three subgroups by BMI: <24 kg/m², 24–27.9 kg/m², and ≥28 kg/m². The primary outcome was change in affected-limb volume, and quality of life was assessed using LYMQOL. Outcome assessors were blinded to group allocation. Results At 6 months, affected-limb volume decreased by 32.1 ± 6.2% in the intervention group and 14.3 ± 5.8% in the control group (P<0.01). LYMQOL scores improved by 15.2 ± 3.1 and 6.8 ± 2.9 points, respectively (P<0.01). Exploratory subgroup analysis suggested a greater volume reduction among participants with BMI ≥28 kg/m² than among those with BMI 24-27.9 kg/m² (P = 0.02). Three participants in the intervention group developed transient skin redness, and no serious adverse events were reported. Conclusion In patients with LEL after gynecological cancer surgery, the BMI-stratified integrated intervention was associated with greater improvement in limb volume and quality of life than conventional care over 6 months. Clinical trial registration ClinicalTrials.gov , identifier NCT07374835.