Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis

Purushothaman Natarajan; Gayathri Delanerolle; Lucy Dobson; Cong Xu; Yutian Zeng; Xuan Yu; Kathleen Marston; Thuan Phan; Fiona Choi; Vanya Barzilova; Simon G. Powell; James Wyatt; Sian Taylor; Jian Qing Shi; Dharani K. Hapangama

doi:10.3390/cancers16101860

Cancers (May 2024)

Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis

Purushothaman Natarajan,
Gayathri Delanerolle,
Lucy Dobson,
Cong Xu,
Yutian Zeng,
Xuan Yu,
Kathleen Marston,
Thuan Phan,
Fiona Choi,
Vanya Barzilova,
Simon G. Powell,
James Wyatt,
Sian Taylor,
Jian Qing Shi,
Dharani K. Hapangama

Affiliations

Purushothaman Natarajan: Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
Gayathri Delanerolle: Institute of Applied Health Research, College of Medicine, University of Birmingham, Vincent Drive, Edgbaston B15 2TT, UK
Lucy Dobson: Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
Cong Xu: Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
Yutian Zeng: Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
Xuan Yu: Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
Kathleen Marston: Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
Thuan Phan: Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
Fiona Choi: Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
Vanya Barzilova: Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
Simon G. Powell: Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
James Wyatt: Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
Sian Taylor: Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
Jian Qing Shi: Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
Dharani K. Hapangama: Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK

DOI: https://doi.org/10.3390/cancers16101860
Journal volume & issue: Vol. 16, no. 10
p. 1860

Abstract

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Background: Total hysterectomy with bilateral salpingo-oophorectomy via minimally invasive surgery (MIS) has emerged as the standard of care for early-stage endometrial cancer (EC). Prior systematic reviews and meta-analyses have focused on outcomes reported solely from randomised controlled trials (RCTs), overlooking valuable data from non-randomised studies. This inaugural systematic review and network meta-analysis comprehensively compares clinical and oncological outcomes between MIS and open surgery for early-stage EC, incorporating evidence from randomised and non-randomised studies. Methods: This study was prospectively registered on PROSPERO (CRD42020186959). All original research of any experimental design reporting clinical and oncological outcomes of surgical treatment for endometrial cancer was included. Study selection was restricted to English-language peer-reviewed journal articles published 1 January 1995–31 December 2021. A Bayesian network meta-analysis was conducted. Results: A total of 99 studies were included in the network meta-analysis, comprising 181,716 women and 14 outcomes. Compared with open surgery, laparoscopic and robotic-assisted surgery demonstrated reduced blood loss and length of hospital stay but increased operating time. Compared with laparoscopic surgery, robotic-assisted surgery was associated with a significant reduction in ileus (OR = 0.40, 95% CrI: 0.17–0.87) and total intra-operative complications (OR = 0.38, 95% CrI: 0.17–0.75) as well as a higher disease-free survival (OR = 2.45, 95% CrI: 1.04–6.34). Conclusions: For treating early endometrial cancer, minimal-access surgery via robotic-assisted or laparoscopic techniques appears safer and more efficacious than open surgery. Robotic-assisted surgery is associated with fewer complications and favourable oncological outcomes.

Published in Cancers

ISSN: 2072-6694 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.mdpi.com/journal/cancers/

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