Does the prophylactic use of compression garments reduce the risk of lower limb lymphedema after pelvic and/or inguinal lymphadenectomy for gynecological cancer? A systematic review

Why clinicians should know about it

• Picked for Obstetrics and Gynecology (paper of the day, 30 July 2026).

Abstract

OBJECTIVE: Our goal was to assess whether prophylactic compression garments reduce lower-limb lymphedema after pelvic/inguinal lymphadenectomy for gynecologic malignancies. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.-based systematic review. Eligible studies included primary interventional studies evaluating prophylactic lower-limb compression after pelvic and/or inguinal lymphadenectomy for gynecological malignancies; systematic/rapid reviews were considered for contextual background and reference checking; studies focused on treatment of established lymphedema or non-relevant populations/outcomes were excluded. The Population, Intervention, Comparison, Outcome question was: in women undergoing pelvic and/or inguinal lymphadenectomy for gynecological malignancy (P), does prophylactic use of compression garments (I), compared with no compression garments or non-compressive preventive strategies (C), reduce the incidence of lower-limb lymphedema (O)? PubMed, Scopus, Cochrane, LILACS, and SciELO were searched from inception through March8 2026, using Medical Subject Headings and free-text terms related to compression garments, lymphedema prevention, pelvic or inguinal lymphadenectomy, gynecological cancer, and lower-limb lymphedema. RESULTS: A total of 536 full-text reports were assessed; 6 gynecological oncology randomized controlled trials met the Population, Intervention, Comparison, Outcome criteria; one additional mixed-population randomized controlled trial was treated as indirect evidence. Two systematic/rapid reviews were used for contextual background/reference checking; multimodal prevention studies were discussed as evidence for multimodal pathways because compression effects could not be isolated. Randomized controlled trials were heterogeneous: small trials using class I to II stockings did not demonstrate a significant reduction in lower-limb lymphedema, although they suggested a potential benefit. One randomized controlled trial (n = 64) showed a reduction in lymphedema incidence (3.4% vs 38.7%) with class II (23-32 mmHg) stockings worn for 12 months, alongside education and physical activity. CONCLUSIONS: Prophylactic compression-particularly early, prolonged class II stockings within structured rehabilitation-was associated with lower lymphedema incidence in some studies; evidence remains limited by small, heterogeneous trials, no meta-analysis, and multimodal interventions where compression effects cannot be isolated.

Abstract as published, via PubMed.