Does the effect of early manual lymphatic drainage during postoperative hospital stay prevent the development of lower limb lymphedema after gynecologic cancer surgery? A real-world cohort study

Objective To investigate how early manual lymphatic drainage can prevent lower limb lymphedema (LLL) following real-world gynecological cancer surgery. Methods A total of 342 patients with gynecological cancers underwent radical surgery at a Guangxi cancer hospital between January 3 and February 15, 2025 were included. In order to ascertain the implementation of preventive manual lymphatic drainage (MLD) following surgery, patients were categorized into a prophylaxis group and a control group according to their selection. To control for potential confounding factors, a 1:1 propensity score-matching (PSM) method was used. Using the gynecological lymphedema questionnaire (GLQ) at least 6 months after surgery, we investigated the incidence of LLL and the status of preventive strategies after the intervention. Results After PSM, 111 pairs of score-matched patients were generated. The prophylaxis group’s LLL incidence was 10.81%, substantially lower than the control group’s 21.62% ( P = 0.04). 15.6% of patients in the control group and 38.9% of patients in the prophylaxis group engaged in preventive activities ( P $\lt$ 0.001). 71.7% of patients with GCLQ scores ≥ 4 took action to prevent LLL progression. The prophylaxis group showed a significantly reduced risk of LLL (risk ratio, 0.50; 95% confidence interval (CI) [0.263–0.949]; P = 0.034). Conclusion The occurrence of postoperative lower limb lymphedema is reduced in gynecologic cancer patients who undergo early manual lymphatic drainage. This offers compelling evidence to inform clinical treatment decisions.