Effect of body mass index on postoperative lymphedema after breast cancer: a systematic review and meta-analysis

Abstract

Background: Upper extremity lymphedema, a major complication post-breast cancer surgery, severely impacts quality of life. While body mass index (BMI) is suggested as a risk factor for postoperative breast cancer-related lymphedema (BCRL), evidence is inconsistent. This meta-analysis systematically evaluates BMI’s impact on postoperative lymphedema to resolve discrepancies and provide accurate insights. Methods: The authors conducted comprehensive literature searches from inception to October 7, 2024, in major English-language databases, including PubMed, Embase, and Cochrane. To assess the association between BMI and postoperative BCRL, odds ratio (OR) with 95% confidence intervals (95% CI) were calculated. Subgroup analyses were also performed to evaluate the impact of BMI on postoperative lymphedema in breast cancer patients across different geographic regions. Results: This meta-analysis included 16 studies involving 6,057 postoperative breast cancer patients, with sample sizes ranging from 101 to 1,130. The results revealed a significant association between elevated BMI and postoperative BCRL, with an OR of 2.05 (95% CI, 1.53–2.75; P < 0.005) for patients with BMI ≥ 25 kg/m² compared to those with BMI < 25 kg/m². These findings underscore a significant positive correlation between higher BMI and an increased risk of postoperative lymphedema in breast cancer patients. Conclusions: Our findings demonstrate that a BMI ≥ 25 kg/m² is a significant risk factor for postoperative lymphedema in breast cancer patients. A comprehensive understanding of BMI’s role in lymphedema development post-surgery can inform clinicians and therapists in designing personalized strategies to mitigate this complication.