Meta-Analysis the Prognosis of Surgical Treatment for Early-Stage Invasive Cervical Cancer

Background: The possible advantages of laparoscopic (LPR) and laparotomy (LPT) have not been systematically evaluated. The aim of this study was to systematically review the comparative efficacy between LPR and LPT to treatment cervical cancer, based on perioperative outcomes, complications and long-term outcomes.

Materials and methods: Our research was conducted by searching PubMed, EMBASE and the Cochrane Library database. All the original studies comparing LPR with LPT were included in the critical assessment. Software Revman 5.3 was used for meta-analysis. Average difference and standard deviation (SD) and 95% confidence interval (CI), ratio (ORs), 95% CI and aggregate risk ratio (HRs) and 95% confidence interval (CIs) were used to estimate the association strength between laparoscopic and laparotomy patients.

Results: A total of nine studies that compared LPR (n = 487) with LPT (n = 510) in patients with cervical cancer fulfilled quality criteria were selected for review and meta-analysis. LPR compared with LPT was associated with a significant reduction of intra operative blood loss (weighted mean difference =313.29 ml, 95% CI: -113.69 to 740.28; p=0.15). The mean blood loss was (555.8 ± 304.4) ml in LPT group compared with (180.34 ± 213.9) ml in LPR group. A reduced risk of postoperative complications was seen in LPR (9.72% LPR vs. 13.6% LPT; OR = 1.34; 95 % CI 0.83–2.15; p=0.23); wound infection rate (1.03% LPR vs 4.07% LPT, p = 0.009); fever morbidity (1.29% LPR vs 4.9% LPT, p = 0.004); wound dehiscence (1.55% LPR vs. 5.8% LPT, p = 0.003); The rates of wound infection, febrile morbidity and wound dehiscence were found in the patients of both groups and the results showed that the rate of LPT was higher in all the three complications as compared to the rates of LPR and the difference was statistically significant. The hospital stay was shorter (4.8 ± 2 days) in LPR group compare to LPT group (13.77 ± 4 days; 95% CI: 1.09 to 16.28; p=0.03). The mean operative time for the laparoscopic technique was (247.83 ± 200.45) min which was shorter than the laparotomy group (233.72 ± 139 min). The rate of intra operative complications was similar between two groups(LPR 8.97% versus LPT 6.12%; OR = 0.65; 95% CI 0.38-1.11; p= 0.12); Bladder injury occurred in 4.076% of LPR patients and 1.28% of LPT patients (p = 0.03); Patients with LPT showed less bladder injuries as compared to patients with LPR. The incidence of urethral injury was 2.4% in LPR group and 0.5% in LPT group (p = 0.06); Urethral injuries were also observed to be more in patients with LPR and less in patients with LPT. Vascular injury occurred in 1.63% of patients with LPR and 0.5% of patients with LPT (p = 0.16); vascular injury occurred more in patients with LPR as compared to patients with LPT. There were not significant differences in 5-year OS (hazard ratio [HR]=1.02; 95% CI:0. 60 to 1.70; p=0.95) and progression free survival (hazard ratio [HR]=1.17; 95% CI: 0.64 to 2.14; p=0.61) between two groups. Neither have higher risks of recurrence [hazard ratio (HR) = 0.73; 95% confidence interval (CI) 0.29–1.83; p=0.50] in LPR vs. LPT. Conclusions: LPR treatment for early invasive cervical cancer showed less blood loss and shorter hospital stay than patients receiving LPT. The incidence of intra operative complications was similar between the two groups, but the character was quiet different. There was no significant difference in the 5-year OS, PFS and recurrent risk between the two groups.