Comparison of long-term outcomes of minimally invasive surgery versus
open radical hysterectomy for cervical cancer: A meta-analysis
Abstract
BACKGROUND The use of minimally invasive surgery (MIS) for cervical
cancer remains controversial. OBJECTIVES To compare the long-term
outcomes after experiencing the MIS robot-assisted laparoscopic radical
hysterectomy (RRH) and total laparoscopic radical hysterectomy (LRH))
with traditional total open radical hysterectomy (ORH). SEARCH STRATEGY
Five electronic databases including PubMed and Embase were searched from
inception to January, 2020. SELECTION CRITERIA We included eligible
studies of cervical cancer patients with outcomes of MIS and ORH. DATA
COLLECTION AND ANALYSIS The pooled hazard ratio (HR) or relative risk
(RR) and its 95% confidence interval (CI) of overall survival (OS),
disease-free survival (DFS), progression-free survival (PFS) and
recurrence (R) were pooled. MAIN RESULTS 37 studies (20,133 patients)
were included. Overall, patients in MIS group showed similar prognosis
with those in ORH group (OS HR = 1.11, P = 0.350; DFS HR = 1.08, P =
0.426; PFS HR = 1.04, P = 0.873; recurrence RR = 0.91, P = 0.166). For
those with early stage cervical cancer, the ORH might be a better
prognostic factor for OS than MIS (HR = 1.30, 95% CI: 1.08 - 1.56, P =
0.005), but no significant difference was observed for DFS, PFS and
recurrence (P were 0.364, 0.760 and 0.349, respectively). The OS for LRH
and RRH comparable to ORH (HR: 1.26 vs. 1.30, P interaction = 0.925).
CONCLUSIONS We found that MIS, irrespective of LRH or RRH, might be a
poor prognosis factor for early cervical cancer patients in OS compared
to conventional ORH.