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.