Abstract

Objectives: The primary aim was to assess the impact of surgical (LVA/LVB, VLNT, liposuction/excisional, hybrid) and conservative (CDT/compression, APCD, exercise, biologic/energy-based) interventions on QoL in adults with lower-limb lymphoedema using validated PROMs. Secondary aims were to synthesise domain-specific and generic HRQoL effects, compare outcomes across instruments, summarise cellulitis and compression outcomes, appraise risk of bias and evidence certainty (GRADE), and identify gaps to guide future trials and core outcome development. Introduction: Lower-limb lymphoedema (LLL) causes substantial functional and psychosocial burden. Complex decongestive therapy (CDT) has long been considered standard care, yet lymphatic microsurgery, reductive surgery, and advanced pneumatic compression devices (APCDs) are increasingly used. We synthesised how surgical and conservative interventions affect health-related quality of life (HRQoL). Materials / method: This review, conducted in accordance with PRISMA 2020 guidelines (protocol not registered), systematically searched MEDLINE/PubMed, Embase, CINAHL, and Web of Science (to 10 September 2025), supplemented by reference list screening. Eligible studies involved adults with lower limb lymphoedema receiving surgical (LVA/LVB, VLNT, liposuction/excisional, hybrids) or conservative interventions (CDT/compression, APCD, exercise, PRP, LLLT, LSGB). Primary outcomes were PROMs (LYMQOL, EQ-5D/-5L, SF-36/v2, Lymph-ICF/-LL, WHOQoL-BREF, LEFS). Risk of bias and GRADE were applied; meta-analysis was preclude Results: From 436 records (428 database, 8 references), 347 remained after deduplication; 33 full texts were reviewed and 21 studies included. LVA improved disease-specific and generic QoL and reduced cellulitis despite variable volume change. VLNT improved QoL and satisfaction, with double-inset gastroepiploic VLNT superior to single-inset. Liposuction/hybrids yielded major QoL gains but with morbidity. CDT worked best as adjunct. APCD, exercise, PRP, LLLT, and LSGB showed QoL benefits in selected cohorts. Conclusion: LVA and APCD show the most consistent, multi‐domain QoL benefits and infection reduction, while CDT is best conceptualised as platform/maintenance therapy. Technique‐refined VLNT and targeted reductive/hybrid surgery extend benefits to advanced phenotypes. Certainty of evidence was generally low to moderate, limited by observational designs and imprecision. Adequately powered head‐to‐head trials with standardised PROMs and economic evaluation are needed.