Date Published: March 19, 2018
Publisher: Public Library of Science
Author(s): Yue-Mei Jin, Shan-Shan Liu, Jun Chen, Yan-Nan Chen, Chen-Chen Ren, Qin Liu.
Cervical cancer (CC) continues to be a global burden for women, with higher incidence and mortality rates reported annually. Many countries have witnessed a dramatic reduction in the prevalence of CC due to widely accessed robotic radical hysterectomy (RRH). This network meta-analysis aims to compare intraoperative and postoperative outcomes in way of RRH, laparoscopic radical hysterectomy (LTH) and open radical hysterectomy (ORH) in the treatment of early-stage CC.
A comprehensive search of PubMed, Cochrane Library and EMBASE databases was performed from inception to June 2016. Clinical controlled trials (CCTs) of above three hysterectomies in the treatment of early-stage CC were included in this study. Direct and indirect evidence were incorporated for calculating values of weighted mean difference (WMD) or odds ratio (OR), and drawing the surface under the cumulative ranking curve (SUCRA).
Seventeen 17 CCTs were ultimately enrolled in this network meta-analysis. The network meta-analysis showed that patients treated by RRH and LRH had lower estimated blood loss compared to patients treated by ORH (WMD = -399.52, 95% CI = -600.64~-204.78; WMD = -277.86, 95%CI = -430.84 ~ -126.07, respectively). Patients treated by RRH and LRH had less hospital stay (days) than those by ORH (WMD = -3.49, 95% CI = -5.79~-1.24; WMD = -3.26, 95% CI = -5.04~-1.44, respectively). Compared with ORH, patients treated with RRH had lower postoperative complications (OR = 0.21, 95%CI = 0.08~0.65). Furthermore, the SUCRA value of three radical hysterectomies showed that patients receiving RRH illustrated better conditions on intraoperative blood loss, operation time, the number of resected lymph nodes, length of hospital stay and intraoperative and postoperative complications, while patients receiving ORH demonstrated relatively poorer conditions.
The results of this meta-analysis confirmed that early-stage CC patients treated by RRH were superior to patients treated by LRH and ORH in intraoperative blood loss, length of hospital stay and intraoperative and postoperative complications, and RRH might be regarded as a safe and effective therapeutic procedure for the management of CC.
Cervical cancer (CC) is the 2nd most common female cancer and is the leading cause of death in women . Almost 85% of the CC burden happens in the developed regions and the incidence of CC in developing countries is high . Lack of awareness, ineffective screening programs, being dwarfed by other health priorities and insufficient attention to women’s health are factors contributing to the increasing incidence rate of CC . CC can be detected at early stages and treated appropriately in developed countries like America, however, women in many countries face great challenges as various health care systems are unable to provide regular CC screening tests and treatment . The greatest obstruction in the treatment for CC remains to be the delay in diagnosis and treatment . One of the most frequented approaches for treating patients suffering from early-stage CC is open radical hysterectomy (ORH), contributing to short postoperative hospital stay and postoperative complication . Consistently, radical hysterectomy (RH) is verified to be the main mode of treatment for patients with early-stage CC including International Federation of Gynecology and Obstetrics (FIGO) stages from I to II A . Thus, the comparison of different methods in the treatment of CC is necessary in order to raise the quality of life for women plagued by CC.
In this study, we evaluated three different approaches for hysterectomies in the treatment of CC by summarizing clinical data in a pairwise meta-analysis. Our clinical data supports previous findings and suggests that RRH and LRH have better intraoperative and postoperative outcomes compared to ORH in the treatment of CC. Currently, an increasing number of gynecologists opt for the RRH approach in order to decrease postoperative morbidity . Robot assisted surgery allows greater visualization of the instrument by means of binocular vision, using seven degrees of freedom of the instrument with greater flexibility, and the motion of the damping control is more accurate in 2005. . LRH is performed routinely all around the world, due to the advances in minimally invasive surgery . A recent meta-analysis showed that a comparison of RRH and PRH was not practicable as a result of insufficiency in studies that assessed appropriate “radical” hysterectomy merely for uterine CC . Many clinicians believe that the RRH is associated with a lower incidence of postoperative morbidity compared to the traditional relative humidity, with similar clinical efficacy and safety .
In conclusion, these results of our meta-analysis indicate that patients with early-stage CC treated by RRH had better clinical outcomes of intraoperative blood loss, length of hospital stay and intraoperative and postoperative complications than LRH and ORH, which has a certain guiding significance for the clinical use and treatment of early-stage CC.