Effectiveness and Safety of Laparoscopy Operation versus Laparotomy for Early Stage Cervical Cancer: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 YANGLi ¹ ,  MACai-ling ¹ , ZHAOJun-da ¹ , ZHAOLing-chi ¹ , YEYuan-zheng ²

1. Department of Gynaecology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;
2. Department of Cardiac Function, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

MACai-ling, Email: hymcl@sina.com

Keywords：

Cervical cancer; Laparoscopy; Laparotomy; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20160032

Video：

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Objective To systematically review the effectiveness and safety of laparoscopic operation versus laparotomy for stage I-IIa cervical cancer. Method Databases including PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI were searched to collect controlled trials and cohort studies about laparoscopic operation versus laparotomy for stage I-IIa cervical cancer from inception to July 2014. Two reviewers independently screened literature, extracted data, and evaluated the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 3 RCTs, 4 non-randomized controlled trials and 11 cohort studies involving 2 020 patients were included. The results of meta-analysis showed that, compared with laparotomy, laparoscopy operation could reduce intraoperative blood loss (MD=-247.99, 95%CI -408.90 to -87.07, P=0.003) , the incidence of perioperative blood transfusion (OR=0.33, 95%CI 0.21 to 0.52, P<0.000 01) , haemoglobin level before and after surgery (MD=-0.98, 95%CI -0.13 to -0.93, P<0.000 01) , postoperative complication (OR=0.61, 95%CI 0.40 to 0.93, P=0.02) , and shorten postoperative exhaust time (MD=-17.41, 95%CI -32.79 to -2.03, P=0.03) and postoperative hospitalization days (MD=-2.51, 95%CI -3.25 to -1.78, P<0.000 01) . There were no significant differences between two groups in the number of pelvic lymph nodes removed, operative complications, as well as the recurrence rate, mortality and non-recurrence survivals after 2 to 5 years of follow-up. But the operation time of the laparoscopy operation group was longer than that of the laparotomy group. Conclusions Current evidence shows that compared with laparotomy, laparoscopic operation for early stage cervical cancer has less trauma, less blood loss, shorter hospitalization days and less postoperative complications. Due to the limited quantity of the included studies, more studies are needed to verify the above conclusion.

Citation： YANGLi, MACai-ling, ZHAOJun-da, ZHAOLing-chi, YEYuan-zheng. Effectiveness and Safety of Laparoscopy Operation versus Laparotomy for Early Stage Cervical Cancer: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(2): 200-211. doi: 10.7507/1672-2531.20160032 Copy

1.	丰有吉, 沈铿, 马丁, 等. 妇产科学. 第2版. 北京:人民卫生出版, 2010:325-331.
2.	Lilic V, Lilic G, Filipovic S, et al. Modern treatment of invasive carcinoma of the uterine cervix. J Buon, 2009, 14(4) :587-592.
3.	Querleu D, Leblanc E, Castelain B. Pelvic lymphadenectomy under celioscopic guidance. J Gynecol Obstet Biol Reprod (Paris), 1990, 19(5) :576-578.
4.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic ReViews of Inter Ventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochranehandbook.org.
5.	Slim K, Nini E, Forestier D, et al. Methodological index for nonrandomized studies(minors):development and validation of a new instrument. ANZ J Surg, 2003, 73(9) :712-716.
6.	Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in metaanalyses. Ottawa, Canada:Dept of Epidem iology and Community Medicine, University of Ottawa. Available at:http://www.ohri.ca/programs/clinical-epidemiology/oxford.htm.
7.	Review Manager (RevMan)[Computer program]. Version 5.2. Copenhagen:The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
8.	Naik R, Jackson KS, Lopes A, et al. Laparoscopic assisted radical vaginal hysterectomy versus radical abdominal hysterectomy-a randomized phase II trial:perioperative outcomes and surgicopathological measurements. BJOG, 2010, 117(6) :746-751.
9.	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.
10.	Campos LS, Limberger LF, Stein AT, et al. Postoperative pain and perioperative outcomes after laparoscopic radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer:a randomized controlled trial. Trials, 2013, 14:293.
11.	Nam JH, Kim JH, Kim DY, et al. Comparative study of laparoscopico-vaginal radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer. Gynecol Oncol, 2004, 92(1) :277-283.
12.	Taylor SE, McBee WC Jr, Richard SD, et al. Radical Hysterectomy for Early Stage Cervical Cancer:Laparoscopy Versus Laparotomy. JSLS, 2011, 15(2) :213-217.
13.	Li G, Yan X, Shang H, et al. A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of Ib-IIa cervical cancer. Gynecol Oncol, 2007, 105(1) : 176-180.
14.	Sobiczewski P, Bidzinski M, Derlatka P, et al. Early Cervical Cancer Managed by Laparoscopy and Conventional Surgery Comparison of Treatment Results. Int J Gynecol Cancer, 2009, 19(8) :1390-1395.
15.	Morgan DJ, Hunter DC, McCracken G, et al. Is laparoscopically assisted radical vaginal hysterectomy for cervical carcinoma safe? A case control study with follow up. BJOG, 2007, 114(5) :537-542.
16.	Jackson KS, Das N, Naik R, et al. Laparoscopically assisted radical vaginal hysterectomy vs. radical abdominal hysterectomy for cervical cancer:a match controlled study. Gynecol Oncol, 2004, 95(3) :655-661.
17.	Lee CL, Huang KG, Jain S, et al. Comparison of Laparoscopic and Conventional Surgery in the Treatment of Early Cervical Cancer. J Am Assoc Gynecol Laparosc, 2002, 9(4) :481-487.
18.	Zakashansky K, Chuang L, Gretz H, et al. A case controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterecto my in a fellowship training program. Int J Gynecol Cancer, 2007, 17(5) : 1075-1082.
19.	Frumovitz M, dos Reis R, Sun CC, et al. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol, 2007, 110(1) :96-102.
20.	Jaume Pahisa, Sergio MR, et al. Comparative study of laparoscopically assisted radical vaginal hysterectomy and open Wertheim-Meigs in patients with early-stage cervical cancer:eleven years of experience. Int J Gynecol Cancer, 2010, 20(1) :173-178.
21.	Steed H, Rosen B, Murphy J, et al. A comparison of laparascopicassisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer. Gynecol Oncol, 2004, 93(3) :588-593.
22.	Lee EJ, Kang H, Kim DH, et al. Acomparative study of laparoscopic radical hysterectomy with radical abdominal hysterectomy for earlystage cervical cancer:a long-term follow-up study. Eur J Obstet Gynecol Reprod Biol, 2011, 156(1) :83-86.
23.	Nam JH, Kim JH, Kim DY, et al. Comparative study of laparoscopicvaginal radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer. Gynecol Oncol, 2004, 92(1) :277-283.
24.	Simsek T, Ozekinci M, Saruhan Z, et al. Laparoscopic surgery compared to traditional abdominal surgery in the management of early stage cervical cancer. Eur J Gynaec Oncol, 2012, 33(4) :395-398.
25.	Sharma R, Bailey J, Anderson R, et al. Laparoscopically assisted radical vaginal hysterectomy (Coelio-Schauta):A comparison with open Wertheim/Meigs hysterectomy. Int J Gynecol Cancer, 2006, 16(5) :1927-1932.
26.	郑亚峰, 施如霞. 腹腔镜下广泛子宫切除和盆腔淋巴结清扫术治疗早期宫颈癌与开腹手术的比较分析. 使用临床医药杂志, 2012, 16(15) :50-53.
27.	王刚, 李光仪, 陈蔚瑜, 等. 腹腔镜手术与开腹手术治疗早期子宫颈癌的对比分析. 实用妇产科杂志, 2003, 19(4) :301-303.
28.	李光仪, 陈蔚瑜, 王刚. 腹腔镜手术治疗子宫恶性肿瘤52例分析. 中国实用妇科与产科杂志, 2003, 19(3) :476-477.
29.	Larciprete G, Casal B, Segatore MF, et al. Pelvic lymphadenectomy for cervical cancer:extraperitoneal versus laparoscopic approach. Eur J Obstet gynecol Rreprod Biol, 2006, 126(2) :259-263.
30.	赵霞, 潘晓琳, 刘兆春. 宫颈癌根治术腹腔镜与开腹手术疗效对比分析. 农垦医学, 2010, 32(5) :403-406.
31.	Sakuragi N, Todo Y, Kudo M, et al. A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function. Int J Gynecol Cancer, 2005, 15(2) :389-397.
32.	Vanden TS, Kenter GG, Peters AA, et al. Nerve-sparing radical hysterectomy:local recurrence rate, feasibility, and safety in cervical cancer patients stage IA to IIA. Int J Gynecol Cancer, 2009, 19(1) :39-45.

1. 丰有吉, 沈铿, 马丁, 等. 妇产科学. 第2版. 北京:人民卫生出版, 2010:325-331.
2. Lilic V, Lilic G, Filipovic S, et al. Modern treatment of invasive carcinoma of the uterine cervix. J Buon, 2009, 14(4) :587-592.
3. Querleu D, Leblanc E, Castelain B. Pelvic lymphadenectomy under celioscopic guidance. J Gynecol Obstet Biol Reprod (Paris), 1990, 19(5) :576-578.
4. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic ReViews of Inter Ventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochranehandbook.org.
5. Slim K, Nini E, Forestier D, et al. Methodological index for nonrandomized studies(minors):development and validation of a new instrument. ANZ J Surg, 2003, 73(9) :712-716.
6. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in metaanalyses. Ottawa, Canada:Dept of Epidem iology and Community Medicine, University of Ottawa. Available at:http://www.ohri.ca/programs/clinical-epidemiology/oxford.htm.
7. Review Manager (RevMan)[Computer program]. Version 5.2. Copenhagen:The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
8. Naik R, Jackson KS, Lopes A, et al. Laparoscopic assisted radical vaginal hysterectomy versus radical abdominal hysterectomy-a randomized phase II trial:perioperative outcomes and surgicopathological measurements. BJOG, 2010, 117(6) :746-751.
9. 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.
10. Campos LS, Limberger LF, Stein AT, et al. Postoperative pain and perioperative outcomes after laparoscopic radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer:a randomized controlled trial. Trials, 2013, 14:293.
11. Nam JH, Kim JH, Kim DY, et al. Comparative study of laparoscopico-vaginal radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer. Gynecol Oncol, 2004, 92(1) :277-283.
12. Taylor SE, McBee WC Jr, Richard SD, et al. Radical Hysterectomy for Early Stage Cervical Cancer:Laparoscopy Versus Laparotomy. JSLS, 2011, 15(2) :213-217.
13. Li G, Yan X, Shang H, et al. A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of Ib-IIa cervical cancer. Gynecol Oncol, 2007, 105(1) : 176-180.
14. Sobiczewski P, Bidzinski M, Derlatka P, et al. Early Cervical Cancer Managed by Laparoscopy and Conventional Surgery Comparison of Treatment Results. Int J Gynecol Cancer, 2009, 19(8) :1390-1395.
15. Morgan DJ, Hunter DC, McCracken G, et al. Is laparoscopically assisted radical vaginal hysterectomy for cervical carcinoma safe? A case control study with follow up. BJOG, 2007, 114(5) :537-542.
16. Jackson KS, Das N, Naik R, et al. Laparoscopically assisted radical vaginal hysterectomy vs. radical abdominal hysterectomy for cervical cancer:a match controlled study. Gynecol Oncol, 2004, 95(3) :655-661.
17. Lee CL, Huang KG, Jain S, et al. Comparison of Laparoscopic and Conventional Surgery in the Treatment of Early Cervical Cancer. J Am Assoc Gynecol Laparosc, 2002, 9(4) :481-487.
18. Zakashansky K, Chuang L, Gretz H, et al. A case controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterecto my in a fellowship training program. Int J Gynecol Cancer, 2007, 17(5) : 1075-1082.
19. Frumovitz M, dos Reis R, Sun CC, et al. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol, 2007, 110(1) :96-102.
20. Jaume Pahisa, Sergio MR, et al. Comparative study of laparoscopically assisted radical vaginal hysterectomy and open Wertheim-Meigs in patients with early-stage cervical cancer:eleven years of experience. Int J Gynecol Cancer, 2010, 20(1) :173-178.
21. Steed H, Rosen B, Murphy J, et al. A comparison of laparascopicassisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer. Gynecol Oncol, 2004, 93(3) :588-593.
22. Lee EJ, Kang H, Kim DH, et al. Acomparative study of laparoscopic radical hysterectomy with radical abdominal hysterectomy for earlystage cervical cancer:a long-term follow-up study. Eur J Obstet Gynecol Reprod Biol, 2011, 156(1) :83-86.
23. Nam JH, Kim JH, Kim DY, et al. Comparative study of laparoscopicvaginal radical hysterectomy and abdominal radical hysterectomy in patients with early cervical cancer. Gynecol Oncol, 2004, 92(1) :277-283.
24. Simsek T, Ozekinci M, Saruhan Z, et al. Laparoscopic surgery compared to traditional abdominal surgery in the management of early stage cervical cancer. Eur J Gynaec Oncol, 2012, 33(4) :395-398.
25. Sharma R, Bailey J, Anderson R, et al. Laparoscopically assisted radical vaginal hysterectomy (Coelio-Schauta):A comparison with open Wertheim/Meigs hysterectomy. Int J Gynecol Cancer, 2006, 16(5) :1927-1932.
26. 郑亚峰, 施如霞. 腹腔镜下广泛子宫切除和盆腔淋巴结清扫术治疗早期宫颈癌与开腹手术的比较分析. 使用临床医药杂志, 2012, 16(15) :50-53.
27. 王刚, 李光仪, 陈蔚瑜, 等. 腹腔镜手术与开腹手术治疗早期子宫颈癌的对比分析. 实用妇产科杂志, 2003, 19(4) :301-303.
28. 李光仪, 陈蔚瑜, 王刚. 腹腔镜手术治疗子宫恶性肿瘤52例分析. 中国实用妇科与产科杂志, 2003, 19(3) :476-477.
29. Larciprete G, Casal B, Segatore MF, et al. Pelvic lymphadenectomy for cervical cancer:extraperitoneal versus laparoscopic approach. Eur J Obstet gynecol Rreprod Biol, 2006, 126(2) :259-263.
30. 赵霞, 潘晓琳, 刘兆春. 宫颈癌根治术腹腔镜与开腹手术疗效对比分析. 农垦医学, 2010, 32(5) :403-406.
31. Sakuragi N, Todo Y, Kudo M, et al. A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function. Int J Gynecol Cancer, 2005, 15(2) :389-397.
32. Vanden TS, Kenter GG, Peters AA, et al. Nerve-sparing radical hysterectomy:local recurrence rate, feasibility, and safety in cervical cancer patients stage IA to IIA. Int J Gynecol Cancer, 2009, 19(1) :39-45.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Laparoscopy Operation versus Laparotomy for Early Stage Cervical Cancer: A Meta-analysis

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