Safety and efficacy of Da Vinci surgical system versus laparoscopy for surgical staging of endometrial cancer: a Meta-analysis

Abstract

Objective To evaluate the safety and efficacy between Da Vinci surgical system (DVSS) and laparoscopy for surgical staging of endometrial cancer. Methods All the non-randomized controlled trials (NRCT) about robotic surgery and laparoscopy for surgical staging of endometrial cancer were electronically collected by searching English databases, including Cochrane library, PubMed, Embase, Web of Science (WOS), and Chinese databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (CSTJ). Meanwhile, Journal of International Oncology, Journal of Practical Obstetrics and Gynecology, Chinese Journal of Obstetrics and Gynecology, Chinese Journal of Practical Gynecology and Obstetrics, Progress in Obstetrics and Gynecology were manually searched to collect NRCT about the same topic. Retrieval time ranged from January 1, 2007 to August 31, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, Meta-analysis was performed by using RevMan 5.3 software.Heterogeneity inspection was done for each study, and different effect model, included the random effect model and fixed effect model was chose according to the results of the heterogeneity inspection. Meta-analysis was conducted to evaluate the efficacy and safety between robotic surgery and laparoscopy for surgical staging of endometrial cancer. The safety indexes included intraoperative blood loss, hospital stay, conversion to open surgery, blood transfusion rate, intraoperative and postoperative complications. The efficacy indexes included operation duration, the number of pelvic lymph node dissection and para-aortic lymph node dissection. Results A total of eight English NRCTs involving 1 118 patients were included.Among them, 499 patients received robotic surgery and 619 patients received laparoscopic surgery.All the 8 articles were cohort study, 3 were prospective cohort study, while 5 were retrospective cohort study. After the quality assessment, all studies were high quality. Meta-analysis showed the following results. ① In term of the safty, compared with laparoscopy surgery, robotic surgery had less intraoperative blood loss (SMD=-88.95, 95%CI: -102.42--75.47, P<0.001), shorter hospital stay (SMD=-0.40, 95%CI: -0.75--0.06, P=0.02), lower rate of conversion to open surgery (RR=0.37, 95%CI: 0.17-0.81, P=0.01), and lower rate of intraoperative or postoperative complications (RR=0.67, 95%CI: 0.51-0.87, P=0.003). But there was no statistically significant difference in term of blood transfusion rate (RR=0.76, 95%CI: 0.39-1.50, P=0.43). ②In terms of efficacy, there were no statistically significant differences in aspects of operative duration (SMD=3.21, 95%CI: -21.51-27.93, P=0.80), the number of pelvic lymph node dissection (SMD=-0.23, 95%CI: -3.06-2.60, P=0.87) and the number of para-aortic lymph node dissection (SMD=0.77, 95%CI: -1.69-3.23, P=0.54). Conclusions Compared the robotic surgery with laparoscopic surgery in surgical staging of endometrial cancer, robotic surgery has less intraoperative blood loss, lower rate of conversion to open surgery, lower rate of intraoperative or postoperative complications and shorter hospital stay. But the cost of robotic surgery is still expensive which restricts clinical application. Key words: Endometrial neoplasms; Robotics; Laparoscopes; Cohort studies; Meta-analysis; Women