Objective To assess the efficacy and safety of laparoscopic staging and surgery for patients with cervical cancer.
Methods We searched The Cochrane Library, MEDLINE, EMbase, CBM (from inception to 2009). Randomized controlled trials (RCTs) were identified according to the inclusion and exclusion criteria, and then the quality of included trials was accessed, and the data were extracted. Meta-analysis was performed by RevMan 5.0.2 software.
Results Two RCTs involving 120 participants were included. The results of meta-analyses showed laparoscopic surgery, compared with open surgery, shortened postoperative ileus time (MD= –18.20, 95%CI –22.20 to –14.20, P lt;0.001), reduced the postoperative pain (MD= –1.30, 95%CI –1.86, to –0.74, P lt;0.001) and shortened the overall hospital stay (MD= –1.30, 95%CI –1.59 to –1.01, P lt;0.001). Currently, no evidence supported the superiority of laparoscopic surgery on duration of surgery, number of harvested lymph node and intraoperative blood loss over open surgery. Moreover, the laparoscopic surgery neither increased nor decreased the risk of postoperative complications.
Conclusion The laparoscopic staging and surgery could shorten the recovery time of gastrointestinal function, shorten hospital stay, reduce pain in patients, but have no advantages in postoperative complications, operative time, number of lymph node biopsy, and intraoperative blood loss, compared with open surgery. However, the evidence is not b enough because of the low quality of the included studies. Thus, more high-quality RCTs are required in future.
Citation：
YANG Jing,LV Donghao,HE Jia,LIU Hongqian,SHI Gang. Laparoscopic Staging and Surgery for Cervical Cancer: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(5): 592-596. doi: 10.7507/1672-2531.20100454
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Copyright © the editorial department of Chinese Journal of Evidence-Based Medicine of West China Medical Publisher. All rights reserved
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Lilic V, Lilic G, Filipovic S, et al. Modern treatment of invasive carcinoma of the uterine cervix. J Buon, 2009, 14(4): 587-592.
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Querleu D, Leblanc E, Castelain B. Pelvic lymphadenectomy under celioscopic guidance. J Gynecol Obstet Biol Reprod (Paris), 1990, 19(5): 576-578.
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Querleu D. Radical hysterectomies by the Schauta-Amreich and Schauta-Stoeckel techniques assisted by celioscopy. J Gynecol Obstet Biol Reprod (Paris), 1991, 20(5): 747-748.
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Nezhat CR, Burrell MO, Nezhat FR, et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol, 1992, 166(3): 864-865.
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Fagotti A, Fanfani F, Longo R, et al. Which role for pre-treatment laparoscopic staging? Gynecol Oncol, 2007, 107(Suppl 1): S101-105.
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Quer leu D, Leblanc E, Cas telain B. Laparoscopic pelvi c lymphadenectomy in the staging of early carcinoma of the cervix. Am J Obstet Gynecol, 1991, 164(2): 579-581.
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Goff BA, Muntz HG, Paley PJ, et al. Impact of surgical staging in women with locally advanced cervical cancer. Gynecol Oncol, 1999, 74(3): 436-442.
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| 8. |
Köhler C, Klemm P, Schau A, et al. Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies. Gynecol Oncol, 2004, 95(1): 52-61.
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Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org.
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Panici PB, Plotti F, Zullo MA, et al. Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecol Oncol, 2006, 103(3): 859-864.
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Lai CH, Huang KG, Hong JH, et al. Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer. Gynecol Oncol, 2003, 89(1): 160-167.
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Ramirez PT, Soliman PT, Schmeler KM, et al. Laparoscopic and robotic techniques for radical hysterectomy in patients with earlystage cervical cancer. Gynecol Oncol, 2008, 110(3 Suppl 2): S21-24.
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- 1. Lilic V, Lilic G, Filipovic S, et al. Modern treatment of invasive carcinoma of the uterine cervix. J Buon, 2009, 14(4): 587-592.
- 2. Querleu D, Leblanc E, Castelain B. Pelvic lymphadenectomy under celioscopic guidance. J Gynecol Obstet Biol Reprod (Paris), 1990, 19(5): 576-578.
- 3. Querleu D. Radical hysterectomies by the Schauta-Amreich and Schauta-Stoeckel techniques assisted by celioscopy. J Gynecol Obstet Biol Reprod (Paris), 1991, 20(5): 747-748.
- 4. Nezhat CR, Burrell MO, Nezhat FR, et al. Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol, 1992, 166(3): 864-865.
- 5. Fagotti A, Fanfani F, Longo R, et al. Which role for pre-treatment laparoscopic staging? Gynecol Oncol, 2007, 107(Suppl 1): S101-105.
- 6. Quer leu D, Leblanc E, Cas telain B. Laparoscopic pelvi c lymphadenectomy in the staging of early carcinoma of the cervix. Am J Obstet Gynecol, 1991, 164(2): 579-581.
- 7. Goff BA, Muntz HG, Paley PJ, et al. Impact of surgical staging in women with locally advanced cervical cancer. Gynecol Oncol, 1999, 74(3): 436-442.
- 8. Köhler C, Klemm P, Schau A, et al. Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies. Gynecol Oncol, 2004, 95(1): 52-61.
- 9. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org.
- 10. Panici PB, Plotti F, Zullo MA, et al. Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecol Oncol, 2006, 103(3): 859-864.
- 11. Lai CH, Huang KG, Hong JH, et al. Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer. Gynecol Oncol, 2003, 89(1): 160-167.
- 12. Ramirez PT, Soliman PT, Schmeler KM, et al. Laparoscopic and robotic techniques for radical hysterectomy in patients with earlystage cervical cancer. Gynecol Oncol, 2008, 110(3 Suppl 2): S21-24.
