We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis.
- Authors
Natarajan, Purushothaman; Delanerolle, Gayathri; Dobson, Lucy; Xu, Cong; Zeng, Yutian; Yu, Xuan; Marston, Kathleen; Phan, Thuan; Choi, Fiona; Barzilova, Vanya; Powell, Simon G.; Wyatt, James; Taylor, Sian; Shi, Jian Qing; Hapangama, Dharani K.
- Abstract
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. 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.
- Subjects
HYSTERECTOMY; SURGICAL robots; PATIENT safety; RESEARCH funding; LAPAROSCOPIC surgery; MINIMALLY invasive procedures; TREATMENT effectiveness; META-analysis; ENDOMETRIAL tumors; OPERATIVE surgery; SYSTEMATIC reviews; ODDS ratio; CONFIDENCE intervals; PROGRESSION-free survival
- Publication
Cancers, 2024, Vol 16, Issue 10, p1860
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16101860