Current Perspectives on the Prevention of Secondary Lymphedema in Women with Gynecologic Cancers: A Narrative Review

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Background: Lower-Limb Lymphedema (LLL) is a chronic and debilitating condition that may develop after treatment for gynecologic cancers. Despite its impact on physical function and quality of life, evidence supporting standardized preventive strategies remains limited. Complex Decongestive Therapy (CDT) is among the preventive and rehabilitative interventions used and includes a structured, multimodal physiotherapy program. This narrative review aims to summarize the current evidence on the prevention and secondary management of LLL. Materials and Methods: A literature search was conducted in PubMed for studies published between 2017 and 2025 using keywords related to “gynecologic cancer,” “lymphedema,” “prevention,” and “exercise.” Five Randomized Controlled Trials (RCTs) were included. Studies focusing on breast cancer-related lymphedema were excluded. Results: Early preventive interventions initiated after surgery or during chemotherapy reduced the incidence of lymphedema or prolonged the lymphedema-free interval. In patients with established lymphedema, multimodal rehabilitation improved limb volume, physical function, symptoms, and quality of life. Follow-up ranged from 4 weeks to 5 years. Discussion: This narrative review highlights the important role of rehabilitative and preventive interventions in the management of lower-limb lymphedema in patients with gynecologic cancers. As reported in the literature, early postoperative CDT significantly prolonged lymphedema-free survival and reduced the incidence of lymphedema (p < 0.05). Exercise and physiotherapy may improve both patient well-being and functional outcomes. Conclusion: Preventive and rehabilitative strategies, despite the heterogeneity of protocols and study designs, appear important for reducing risk and improving quality of life, and early intervention seems crucial. Future research should focus on larger, high-quality trials with standardized diagnostic criteria and outcome measures to establish evidence-based prevention protocols.

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