Prognosis and Efficacy of Laparoscopic Surgery on Patients with Endometrial Carcinoma: Systematic Evaluation and Meta-Analysis

摘要

Objective. The prognosis and efficacy of laparoscopic surgery (LPS) and open surgery or robotic surgery (RS) on endometrial carcinoma (EC) patients were compared. Methods. Data as of May 2021 were retrieved from databases like PubMed, Embase, Cochrane Library, and Web of Science. The study involved randomized controlled trials (RCTs), cohort studies, or case-control studies for comparing the effects of LPS and open surgery or robotic surgery (RS) on EC treatment. The primary outcomes included duration of operation, blood loss, length of stay (LOS), postoperative complications, and recurrence rate. Secondary outcomes included 3-year progression-free survival (PFS) rate/disease-free survival (DFS) rate and 3-year overall survival (OS) rate. Results. A total of 24 studies were involved, and all of them were cohort studies except 1 RCT and 1 case-control study. There was no significant difference in duration of operation between LPS and open surgery ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mtext>MD</a:mtext> <a:mo>=</a:mo> <a:mo>−</a:mo> <a:mn>0.06</a:mn> </a:math> , 95% CI: -0.37 to 0.25) or RS ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mtext>MD</c:mtext> <c:mo>=</c:mo> <c:mo>−</c:mo> <c:mn>0.15</c:mn> </c:math> , 95% CI: -1.27 to 0.96). In comparison with the open surgery, LPS remarkably reduced blood loss ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mtext>MD</e:mtext> <e:mo>=</e:mo> <e:mo>−</e:mo> <e:mn>0.43</e:mn> </e:math> , 95% CI: -0.58 to -0.29), LOS ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mtext>MD</g:mtext> <g:mo>=</g:mo> <g:mo>−</g:mo> <g:mn>0.71</g:mn> </g:math> , 95% CI: -0.92 to -0.50), and the complication occurrence rate ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mtext>RR</i:mtext> <i:mo>=</i:mo> <i:mn>0.83</i:mn> </i:math> , 95% CI: 0.73 to 0.95). However, LPS and RS saw no difference in blood loss ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mtext>MD</k:mtext> <k:mo>=</k:mo> <k:mn>0.01</k:mn> </k:math> , 95% CI: -0.77 to 0.79). Besides, in comparison with RS, LPS prominently shortened the LOS ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mtext>MD</m:mtext> <m:mo>=</m:mo> <m:mn>0.26</m:mn> </m:math> , 95% CI: 0.12 to 0.40) but increased the complication occurrence rate ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mtext>RR</o:mtext> <o:mo>=</o:mo> <o:mn>1.74</o:mn> </o:math> , 95% CI: 1.57 to 1.92). In contrast to open surgery or RS, LPS saw no difference in occurrence rate ( <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mtext>RR</q:mtext> <q:mo>=</q:mo> <q:mn>0.75</q:mn> </q:math> , 95% CI: 0.56 to 1.01; <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mtext>RR</s:mtext> <s:mo>=</s:mo> <s:mn>0.97</s:mn> </s:math> , 95% CI: 0.62 to 1.53), 3-year PFS/DFS ( <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mtext>RR</u:mtext> <u:mo>=</u:mo> <u:mn>0.99</u:mn> </u:math> , 95% CI: 0.90 to 1.09; <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"> <w:mtext>RR</w:mtext> <w:mo>=</w:mo> <w:mn>1.30</w:mn> </w:math> , 95% CI: 0.87 to 1.96), and 3-year OS ( <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"> <y:mtext>RR</y:mtext> <y:mo>=</y:mo> <y:mn>0.97</y:mn> </y:math> , 95% CI: 0.91 to 1.04; <ab:math xmlns:ab="http://www.w3.org/1998/Math/MathML" id="M14"> <ab:mtext>RR</ab:mtext> <ab:mo>=</ab:mo> <ab:mn>1.21</ab:mn> </ab:math> , 95% CI: 0.91 to 1.60). Conclusion. In sum, LPS was better than open surgery, which manifested in the aspects of less blood loss, shorter LOS, and fewer complications. LPS, therefore, was the most suitable option for EC patients. Nevertheless, LPS had no advantage over RS, and sufficient prospective RCTs are needed to further confirm its strengths.