Abstract
Background: The comparison of survival outcomes between minimally invasive surgery and open surgery for cervical cancer patients remains controversial. We evaluated the survival outcomes of cervical cancer patients who underwent different surgical approaches.Methods: A literature search was performed in PubMed, Embase, and Cochrane databases up to February 2020, using the MESH terms “minimally invasive surgical procedures” and “Uterine Cervical Neoplasms.” Included were all original comparative studies and trials both published and unpublished in English that were related to minimally invasive surgery and open surgery for cervical cancer patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage < IIB. Begg's and Egger's regressions were used to evaluate publication bias.Results: This meta-analysis included 28 studies enrolling 18,961 patients with cervical cancer. The overall analyses indicated that cervical cancer patients with FIGO 2009 stage < IIB who underwent minimally invasive surgery had a lower rate of OS (HR = 1.43, 95% CI = 1.06–1.92, P = 0.019) and DFS (HR = 1.50, 95% CI = 1.21–1.85, P < 0.001) than those who underwent open surgery. Moreover, minimally invasive surgery could lower OS (HR = 2.30, 95% CI = 1.50–3.52, P < 0.001) and DFS (HR = 1.94, 95% CI = 1.36–2.76, P < 0.001) of cervical cancer patients with FIGO 2009 stage ≤ IB1 compared to open surgery. However, there were no significant differences in OS (HR = 1.07, 95% CI = 0.65–1.76, P = 0.801) and DFS (HR = 1.20, 95% CI = 0.65–2.19, P = 0.559) in patients with tumors < 2 cm between the two groups.Conclusions: Minimally invasive radical hysterectomy was associated with poor survival outcomes compared to open surgery. Patients with FIGO 2009 stage ≤ IB1 cervical cancer who underwent minimally invasive surgery have lower OS and DFS rates than those who underwent open surgery. Therefore, open surgery should be performed for cervical cancer patients. However, patients with tumors < 2 cm might take the most advantage of minimally invasive surgery without increasing poor prognosis. There are some limitations in the meta-analysis, which needs further high-quality multicenter studies to confirm and update our findings.
Highlights
Cervical cancer is the fourth most common cancer and the fourth leading cause of cancer death in women worldwide [1]
Since 2018, the guidelines from the National Comprehensive Cancer Network (NCCN) advise that patients should be carefully informed about the risks and benefits of the different surgical approaches due to the findings of poorer survival outcomes with laparoscopy compared to laparotomy in the Laparoscopic Approach to Cervical Cancer (LACC) Trial [5]
28 comparative studies which met the study inclusion criteria were selected for analysis [5, 10, 12,13,14,15, 29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50]
Summary
Cervical cancer is the fourth most common cancer and the fourth leading cause of cancer death in women worldwide [1]. Radical hysterectomy with pelvic lymphadenectomy is the standard recommended surgical treatment for earlystage cervical cancer patients. With the development of laparoscopic surgery, minimally invasive radical hysterectomy has ever been the standard surgical approach in patients with early-stage cervical cancer [4]. Since 2018, the guidelines from the National Comprehensive Cancer Network (NCCN) advise that patients should be carefully informed about the risks and benefits of the different surgical approaches due to the findings of poorer survival outcomes with laparoscopy compared to laparotomy in the Laparoscopic Approach to Cervical Cancer (LACC) Trial [5]. The latest guidelines from the NCCN advise that abdominal radical hysterectomy is the standard surgical treatment for early-stage cervical cancer patients [6]. We evaluated the survival outcomes of cervical cancer patients who underwent different surgical approaches
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