Laparoscopy versus laparotomy for the management of early stage cervical cancer

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Abstract

Background

The possible advantages of laparoscopic radical hysterectomy (LRH) versus open radical hysterectomy (RH) have not been well reviewed systematically. The aim of this study was to systematically review the comparative effectiveness between LRH and RH in the treatment of cervical cancer based on the evaluation of the Perioperative outcomes, oncological clearance, complications and long-term outcomes.

Methods

The systematic review was conducted by searching PubMed, MEDLINE, EMBASE, the Cochrane Library and BIOSIS databases. All original studies that compared LRH with RH were included for critical appraisal. Data were pooled and analyzed.

Results

A total of twelve original studies that compared LRH ( n = 754) with RH ( n = 785) in patients with cervical cancer fulfilled quality criteria were selected for review and meta-analysis. LRH compared with RH was associated with a significant reduction of intraoperative blood loss (weighted mean difference = −268.4 mL (95 % CI −361.6, −175.1; p < 0.01), a reduced risk of postoperative complications (OR = 0.46; 95 % CI 0.34–0.63) and shorter hospital stay (weighted mean difference = −3.22 days; 95 % CI–4.21, −2.23 days; p < 0.01). These benefits were at the cost of longer operative time (weighted mean difference = 26.9 min (95 % CI 8.08–45.82). The rate of intraoperative complications was similar in the two groups. Lymph nodes yield and positive resection margins were similar between the two groups. There were no significant differences in 5-year overall survival (HR 0.91, 95 % CI 0.48–1.71; p = 0.76) and 5-year disease-free survival (hazard ratio [HR] 0.97, 95 % CI 0.56–1.68; p = 0.91).

Conclusions

LRH shows better short term outcomes compared with RH in patients with cervical cancer. The oncologic outcome and 5-year survival were similar between the two groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-015-1818-4) contains supplementary material, which is available to authorized users.

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Most cited references 28

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Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints.

M Parmar, V. Torri, L. Stewart (1998)

Meta-analyses aim to provide a full and comprehensive summary of related studies which have addressed a similar question. When the studies involve time to event (survival-type) data the most appropriate statistics to use are the log hazard ratio and its variance. However, these are not always explicitly presented for each study. In this paper a number of methods of extracting estimates of these statistics in a variety of situations are presented. Use of these methods should improve the efficiency and reliability of meta-analyses of the published literature with survival-type endpoints.

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Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study.

J-H Nam, J-Y Park, D-Y Kim … (2012)

To compare the long-term survival outcomes between laparoscopic radical hysterectomy (LRH) and open radical hysterectomy (ORH). We matched patients with stage IA2 to IIA cervical cancer with known risk factors for recurrence who underwent ORH and LRH. Compared with ORH (n = 263), LRH (n = 263) did not have higher risks of recurrence [hazard ratio (HR) = 1.28; 95% confidence interval (CI) 0.62-2.64] or death (HR = 1.46; 95% CI 0.62-3.43). Even in patients with tumors >2 cm in diameter, the risks of recurrence (HR = 0.82; 95% CI 0.31-2.16) or death (HR = 1.01; 95% CI 0.35-2.95) were not higher for LRH than for ORH. The LRH and ORH group had 5-year recurrence-free survival rates of 92.8% and 94.4%, respectively (P = 0.499). LRH resulted in significantly lower estimated blood loss (379.6 versus 541.1 ml, P < 0.001) and shorter postoperative hospital stay (12.5 versus 20.3 days, P < 0.001). Intraoperative complication rates were similar in the two groups (6.8% versus 5.7%, P = 0.711), but postoperative complication rate was lower in the LRH than in the ORH group (9.2% versus 21%, P < 0.001). LRH is an oncologically safe alternative to ORH and was associated with fewer postoperative complication and earlier recovery.

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Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection.

C. Nezhat, Louise Burrell, Benedict B Benigno … (1992)

We report the first case of a laparoscopic radical hysterectomy and paraaortic and pelvic lymphadenectomy to treat a stage IA2 carcinoma of the cervix. To our knowledge, a laparoscopic radical hysterectomy with laparoscopic paraaortic lymphadenectomy has not been previously described.

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Author and article information

Contributors

Yao Zhang: sydzy2003@aliyun.com

Zhi-qing Liang: zhi.lzliang@gmail.com

Journal

Journal ID (nlm-ta): BMC Cancer

Journal ID (iso-abbrev): BMC Cancer

Title: BMC Cancer

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2407

Publication date (Electronic): 24 November 2015

Publication date PMC-release: 24 November 2015

Publication date Collection: 2015

Volume: 15

Electronic Location Identifier: 928

Affiliations

[ ]Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, 400038 People’s Republic of China

[ ]Department of Epidemiology, Clinic Epidemiology Center, Third Military Medical University, Chongqing, 400038 People’s Republic of China

Article

Publisher ID: 1818

DOI: 10.1186/s12885-015-1818-4

PMC ID: 4657298

PubMed ID: 26596955

SO-VID: 3f474b63-4a99-427c-8bbc-e95fa343d216

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 10 May 2015

Date accepted : 16 October 2015

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: laparoscopic radical hysterectomy,abdominal radical hysterectomy,meta-analysis,cervical cancer

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: laparoscopic radical hysterectomy, abdominal radical hysterectomy, meta-analysis, cervical cancer

Laparoscopy versus laparotomy for the management of early stage cervical cancer

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Abstract

Background

Methods

Results

Conclusions

Electronic supplementary material

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Karger: Oncology

Most cited references 28

Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints.

Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study.

Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection.

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