Laparoscopic Radical Hysterectomy for Cervical Cancer: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 DUWen-jing ¹ , DENGYun-dan ² , DAIQiang ¹ ,  YANGYong-xiu ³

1. First Clinical Medical School of Lanzhou University, Lanzhou 730000, China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, China;
3. Department of Gynecology and Obstetrics, First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

YANGYong-xiu, Email: yongxiuyang@163.com

Keywords：

Uterine cervical neoplasm; Laparoscopy; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140156

Video：

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Objective To systematically review the effectiveness and safety of laparoscopic radical hysterectomy (LRH) for cervical cancer. Methods We searched PubMed, EMbase, The Cochrane Library (Issue 10, 2013), CBM, CNKI, VIP, WanFang Data (from inception to October, 2013) through computer, and manually searched related journals. Randomized controlled trials (RCTs) on LRH versus abdominal radical hysterectomy (ARH) in the treatment of cervical cancer were identified according to the inclusion and exclusion criteria, data were extracted, and methodological quality of the included studies was accessed by two reviewer independently. Meta-analysis was then performed using RevMan 5.2 software. Results Seven RCTs involving 462 patients were finally included. The results of meta-analysis showed that: there were significant differences between LRH and ARH in the operation time, intraoperative bleeding, recovery time of gastrointestinal function, postoperative pain, postoperative hospital stay, and surgical site infection (MD=20.25, 95%CI 0.26 to 40.24, P=0.05; MD=-56.18, 95%CI-74.84 to-37.52, P < 0.000 01; SMD=-1.54, 95%CI-2.92 to-0.16, P=0.03; MD=-1.37, 95%CI-1.85 to-0.89, P < 0.000 01; MD=-2.32, 95%CI-3.57 to-1.06, P=0.000 3; RR=0.42, 95%CI 0.18 to 0.97, P=0.04). But there was no significant difference in the number of lymph node biopsy (MD=1.34, 95%CI-4.26 to 6.94, P=0.64) and some operative complications (lymphocyte: RR=1.19, 95%CI 0.54 to 2.63, P=0.66; DVT: RR=1.23, 95%CI 0.48 to 3.20, P=0.67; urinary retention: RR=0.85, 95%CI 0.41 to 1.75, P=0.66; cystotomy: RR=1.91, 95%CI 0.49 to 7.51, P=0.35). Conclusion Current evidence shows that although applying LRH costs longer time, and with high-level technology, its safety and short-term efficacy are superior to ARH. Due to the limited quantity and quality of the included studies, its long-term efficacy still needs to be further confirmed by conducting more high-quality, multi-centre RCTs with large sample size.

Citation： DUWen-jing, DENGYun-dan, DAIQiang, YANGYong-xiu. Laparoscopic Radical Hysterectomy for Cervical Cancer: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(8): 934-941. doi: 10.7507/1672-2531.20140156 Copy

1.	Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 2010, 27(12): 2893-2917.
2.	郎景和.迎接子宫颈癌预防的全球挑战与机遇.中华妇产科杂志, 2002, 37(3): 129-131.
3.	马丁, 奚玲.宫颈癌流行病学及病因学研究进展.实用妇产科杂志, 2001, 17(2): 61-62.
4.	Filippeschi M, Moncini I, Bianchi B, et al. What kind of surgery for cervical carcinoma? G Chir, 2012, 33(4): 139-146.
5.	Watson M, Saraiya M, Wu X. Update of HPV-associated female genital cancers in the United States, 1999-2004. J Womens Health (Larchmt), 2009, 18(11): 1731-1738.
6.	Benedet JL, Bender H, Jones H, et al. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet, 2000, 70(2): 209-262.
7.	Lilic V, Lilic G, Filipovic S, et al. Modern treatment of invasive carcinoma of the uterine cervix. J BUON, 2009, 14(4): 587-592.
8.	Querleu D, Leblanc E, Castelain B. Pelvic lymphadenectomy under celioscopic guidance. J Gynecol Obstet Biol Reprod (Paris), 1990, 19(5): 576-578.
9.	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.
10.	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.
11.	Kluivers KB, Hendriks JC, Mol BW, et al. Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial. J Minim Invasive Gynecol, 2007, 14(2): 145-152.
12.	Medeiros LR, Stein AT, Fachel J, et al. Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis. Int J Gynecol Cancer, 2008, 18(3): 387-399.
13.	FIGO staging for carcinoma of the vulva, cervix, and corpus uteri. Int J Gynaecol Obstet, 2014, 125(2): 97-98.
14.	Higgins JPT, Green S (editors).Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.
15.	Lai CH, Huang KG, Hong JH, et al. Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer. Gynecologic Oncology, 2003, 89(1): 160-167.
16.	Panici PB, Plotti F, Zullo MA, et al. Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecologic Oncology, 2006, 103(3): 859-864.
17.	Campos LS, Leo FL, Airton TS, et al. Postoperative pain and perioperative outcomes after laparoscopic radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer: a randomised controlled trial. Trials, 2013, 14(1): 293.
18.	郭红丽.腹腔镜下宫颈癌根治术32例疗效观察.山东医药, 2010(47): 74-75.
19.	毛莉, 李波.腹腔镜下子宫颈癌根治术治疗早期宫颈癌的疗效分析.中国实用医药, 2012(25): 20-21.
20.	汪君丽.腹腔镜手术与开腹手术治疗早期宫颈癌临床比较.中国乡村医药, 2013, 20(10): 22-23.
21.	王桂春. 50例腹腔镜下宫颈癌根治术的临床疗效研究.中国中医药咨讯, 2011, 3(15): 7-8.
22.	Jiang L, Yang KH, Guan QL, et al. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials. Surg Endosc, 2013, 27(7): 2466-2480.
23.	Langebrekke A, Istre O, Hallqvist AC, et al. Comparison of laparoscopy and laparotomy in patients with endometrial cancer. J Am Assoc Gynecol Laparosc, 2002, 9(2): 152-157.
24.	Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 2000, 56(2): 455-463.
25.	Ioannidis JP, Lau J. Can quality of clinical trials and meta-analyses be quantified? Lancet, 1998, 352(9128): 590-591.
26.	Ng TT, McGory ML, Ko CY, et al. Meta-analysis in surgery: methods and limitations. Arch Surg, 2006, 141(11): 1125-1130.
27.	Lee EJ, Kang H, Kim DH. A comparative study of laparoscopic radical hysterectomy with radical abdominal hysterectomy for early-stage cervical cancer: a long-term follow-up study. Eur J Obstet Gynecol Reprod Biol, 2011, 156(1): 83-86.
28.	Nam JH, Park JY, Kim DY, et al. Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study. Ann Oncol, 2012, 23(4): 903-911.
29.	Obermair A, Gebski V, Frumovitz M, et al. A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. JMIG, 2008, 15(5): 584-588.
30.	Park JY, Kim DY, Kim JH, et al. Laparoscopic versus open radical hysterectomy in patients with stage IB2 and IIA2 cervical cancer. J Surg Oncol, 2013, 108(1): 63-69.
31.	李涛, 穆博然.腹腔镜辅助根治性子宫切除术治疗宫颈癌效果的Meta分析.肿瘤学杂志, 2012, 18(2): 127-133.
32.	熊巍, 杨佳欣, 吴鸣, 等.子宫颈癌腹腔镜与开腹下广泛性子宫切除及淋巴结清扫术的对比分析.生殖医学杂志, 2013, 22(5): 307-311.
33.	Vrzackova P, Weiss P, Cibula D. Sexual morbidity following radical hysterectomy for cervical cancer. Expert Rev Anticancer Ther, 2010, 10(7): 1037-1042.
34.	Tangjitgamol S, Manusirivithaya S, Hanprasertpong J, et al. Sexual dysfunction in Thai women with early-stage cervical cancer after radical hysterectomy. Int J Gynecol Cancer, 2007, 17(5): 1104-1112.
35.	Serati M, Salvatore S, Uccella S, et al. Sexual function after radical hysterectomy for early-stage cervical cancer: is there a difference between laparoscopy and laparotomy? J Sex Med, 2009, 6(9): 2516-2522.
36.	Yang ZJ, Chen YL, Yao DS, et al. Impact on survival and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy to patients with early-stage cervical cancer. Chinese Journal of Obstetrics and Gynecology, 2011, 46(11): 854-859.
37.	颜笑健, 李光仪, 尚慧玲, 等.子宫恶性肿瘤患者腹腔镜与开腹淋巴结清扫术后近期生存质量的比较.中国内镜杂志, 2009, 15(6): 561-564.

1. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 2010, 27(12): 2893-2917.
2. 郎景和.迎接子宫颈癌预防的全球挑战与机遇.中华妇产科杂志, 2002, 37(3): 129-131.
3. 马丁, 奚玲.宫颈癌流行病学及病因学研究进展.实用妇产科杂志, 2001, 17(2): 61-62.
4. Filippeschi M, Moncini I, Bianchi B, et al. What kind of surgery for cervical carcinoma? G Chir, 2012, 33(4): 139-146.
5. Watson M, Saraiya M, Wu X. Update of HPV-associated female genital cancers in the United States, 1999-2004. J Womens Health (Larchmt), 2009, 18(11): 1731-1738.
6. Benedet JL, Bender H, Jones H, et al. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet, 2000, 70(2): 209-262.
7. Lilic V, Lilic G, Filipovic S, et al. Modern treatment of invasive carcinoma of the uterine cervix. J BUON, 2009, 14(4): 587-592.
8. Querleu D, Leblanc E, Castelain B. Pelvic lymphadenectomy under celioscopic guidance. J Gynecol Obstet Biol Reprod (Paris), 1990, 19(5): 576-578.
9. 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.
10. 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.
11. Kluivers KB, Hendriks JC, Mol BW, et al. Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial. J Minim Invasive Gynecol, 2007, 14(2): 145-152.
12. Medeiros LR, Stein AT, Fachel J, et al. Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis. Int J Gynecol Cancer, 2008, 18(3): 387-399.
13. FIGO staging for carcinoma of the vulva, cervix, and corpus uteri. Int J Gynaecol Obstet, 2014, 125(2): 97-98.
14. Higgins JPT, Green S (editors).Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.
15. Lai CH, Huang KG, Hong JH, et al. Randomized trial of surgical staging (extraperitoneal or laparoscopic) versus clinical staging in locally advanced cervical cancer. Gynecologic Oncology, 2003, 89(1): 160-167.
16. Panici PB, Plotti F, Zullo MA, et al. Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecologic Oncology, 2006, 103(3): 859-864.
17. Campos LS, Leo FL, Airton TS, et al. Postoperative pain and perioperative outcomes after laparoscopic radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer: a randomised controlled trial. Trials, 2013, 14(1): 293.
18. 郭红丽.腹腔镜下宫颈癌根治术32例疗效观察.山东医药, 2010(47): 74-75.
19. 毛莉, 李波.腹腔镜下子宫颈癌根治术治疗早期宫颈癌的疗效分析.中国实用医药, 2012(25): 20-21.
20. 汪君丽.腹腔镜手术与开腹手术治疗早期宫颈癌临床比较.中国乡村医药, 2013, 20(10): 22-23.
21. 王桂春. 50例腹腔镜下宫颈癌根治术的临床疗效研究.中国中医药咨讯, 2011, 3(15): 7-8.
22. Jiang L, Yang KH, Guan QL, et al. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials. Surg Endosc, 2013, 27(7): 2466-2480.
23. Langebrekke A, Istre O, Hallqvist AC, et al. Comparison of laparoscopy and laparotomy in patients with endometrial cancer. J Am Assoc Gynecol Laparosc, 2002, 9(2): 152-157.
24. Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 2000, 56(2): 455-463.
25. Ioannidis JP, Lau J. Can quality of clinical trials and meta-analyses be quantified? Lancet, 1998, 352(9128): 590-591.
26. Ng TT, McGory ML, Ko CY, et al. Meta-analysis in surgery: methods and limitations. Arch Surg, 2006, 141(11): 1125-1130.
27. Lee EJ, Kang H, Kim DH. A comparative study of laparoscopic radical hysterectomy with radical abdominal hysterectomy for early-stage cervical cancer: a long-term follow-up study. Eur J Obstet Gynecol Reprod Biol, 2011, 156(1): 83-86.
28. Nam JH, Park JY, Kim DY, et al. Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study. Ann Oncol, 2012, 23(4): 903-911.
29. Obermair A, Gebski V, Frumovitz M, et al. A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. JMIG, 2008, 15(5): 584-588.
30. Park JY, Kim DY, Kim JH, et al. Laparoscopic versus open radical hysterectomy in patients with stage IB2 and IIA2 cervical cancer. J Surg Oncol, 2013, 108(1): 63-69.
31. 李涛, 穆博然.腹腔镜辅助根治性子宫切除术治疗宫颈癌效果的Meta分析.肿瘤学杂志, 2012, 18(2): 127-133.
32. 熊巍, 杨佳欣, 吴鸣, 等.子宫颈癌腹腔镜与开腹下广泛性子宫切除及淋巴结清扫术的对比分析.生殖医学杂志, 2013, 22(5): 307-311.
33. Vrzackova P, Weiss P, Cibula D. Sexual morbidity following radical hysterectomy for cervical cancer. Expert Rev Anticancer Ther, 2010, 10(7): 1037-1042.
34. Tangjitgamol S, Manusirivithaya S, Hanprasertpong J, et al. Sexual dysfunction in Thai women with early-stage cervical cancer after radical hysterectomy. Int J Gynecol Cancer, 2007, 17(5): 1104-1112.
35. Serati M, Salvatore S, Uccella S, et al. Sexual function after radical hysterectomy for early-stage cervical cancer: is there a difference between laparoscopy and laparotomy? J Sex Med, 2009, 6(9): 2516-2522.
36. Yang ZJ, Chen YL, Yao DS, et al. Impact on survival and quality of life of laparoscopic radical hysterectomy and pelvic lymphadenectomy to patients with early-stage cervical cancer. Chinese Journal of Obstetrics and Gynecology, 2011, 46(11): 854-859.
37. 颜笑健, 李光仪, 尚慧玲, 等.子宫恶性肿瘤患者腹腔镜与开腹淋巴结清扫术后近期生存质量的比较.中国内镜杂志, 2009, 15(6): 561-564.

Chinese Journal of Evidence-Based Medicine

Laparoscopic Radical Hysterectomy for Cervical Cancer: A Meta-Analysis

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