Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis

Natarajan, Purushothaman1,2; Delanerolle, Gayathri3; Dobson, Lucy1,2; Xu, Cong4; Zeng, Yutian4; Yu, Xuan4; Marston, Kathleen1; Phan, Thuan1; Choi, Fiona1,2; Barzilova, Vanya1; Powell, Simon G.1; Wyatt, James1; Taylor, Sian2; Shi, Jian Qing4,5; Hapangama, Dharani K.1,2

2024-05-01

10.3390/cancers16101860

CANCERS   影响因子和分区

2072-6694

Simple Summary Keyhole surgery has replaced open surgery as the gold standard of care in the surgical treatment of cancer of the womb. Previous reviews comparing keyhole and open surgery exclusively analysed data from randomised control trials. We present a comprehensive review using randomised and non-randomised trials to compare keyhole surgery and open surgery. This review investigates benefits, complications and long-term outcomes in terms of survival after treatment of cancer of the womb, and it shows that keyhole surgery lessened blood loss and the length of hospital stay compared to open surgery. Among the keyhole methods, robotic surgery decreased some complications while rendering the return of cancer less likely.Abstract Background: Total hysterectomy with bilateral salpingo-oophorectomy via minimally invasive surgery (MIS) has emerged as the standard of care for early-stage endometrial cancer (EC). Prior systematic reviews and meta-analyses have focused on outcomes reported solely from randomised controlled trials (RCTs), overlooking valuable data from non-randomised studies. This inaugural systematic review and network meta-analysis comprehensively compares clinical and oncological outcomes between MIS and open surgery for early-stage EC, incorporating evidence from randomised and non-randomised studies. Methods: This study was prospectively registered on PROSPERO (CRD42020186959). All original research of any experimental design reporting clinical and oncological outcomes of surgical treatment for endometrial cancer was included. Study selection was restricted to English-language peer-reviewed journal articles published 1 January 1995-31 December 2021. A Bayesian network meta-analysis was conducted. Results: A total of 99 studies were included in the network meta-analysis, comprising 181,716 women and 14 outcomes. Compared with open surgery, laparoscopic and robotic-assisted surgery demonstrated reduced blood loss and length of hospital stay but increased operating time. Compared with laparoscopic surgery, robotic-assisted surgery was associated with a significant reduction in ileus (OR = 0.40, 95% CrI: 0.17-0.87) and total intra-operative complications (OR = 0.38, 95% CrI: 0.17-0.75) as well as a higher disease-free survival (OR = 2.45, 95% CrI: 1.04-6.34). Conclusions: For treating early endometrial cancer, minimal-access surgery via robotic-assisted or laparoscopic techniques appears safer and more efficacious than open surgery. Robotic-assisted surgery is associated with fewer complications and favourable oncological outcomes.

laparoscopy minimally invasive surgery minimal access surgery oncological outcomes robotic surgery staging surgical outcomes

SCI

英语

其他

Liverpool Women's Hospital Foundation Trust, Wellbeing of Women[RG2137] ; null[MR/V007238/1]

Oncology

Oncology

WOS:001232589100001

MDPI

Web of Science

1.Univ Liverpool, Inst Life Course & Med Sci, Dept Womens & Childrens Hlth, Liverpool L8 7SS, England
2.Liverpool Womens Hosp NHS Fdn Trust, Liverpool L8 7SS, England
3.Univ Birmingham, Coll Med, Inst Appl Hlth Res, Vincent Dr, Edgbaston B15 2TT, England
4.Southern Univ Sci & Technol, Dept Stat & Data Sci, Shenzhen 518055, Peoples R China
5.Natl Ctr Appl Math Shenzhen, Shenzhen 518038, Peoples R China

Natarajan, Purushothaman,Delanerolle, Gayathri,Dobson, Lucy,et al. Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis[J]. CANCERS,2024,16(10).

Natarajan, Purushothaman.,Delanerolle, Gayathri.,Dobson, Lucy.,Xu, Cong.,Zeng, Yutian.,...&Hapangama, Dharani K..(2024).Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis.CANCERS,16(10).

Natarajan, Purushothaman,et al."Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis".CANCERS 16.10(2024).