Systematic Review And Meta-analysis Of Laparoscopy And Laparotomy On The Endometrial Cancer

Objective: To systematically evaluate the effects of laparoscopy compared with laparotomy in treating endometrial cancer.Methods: Electronic searches was conducted to identify randomised controlled trials (RCTs) for comparing the effects of laparoscopy versus the effects of traditional procedure (laparotomy) in treating endometrial carcinoma. Methodological quality of trials was assessed in terms of generation of allocation sequence, allocation concealment, blinding, and intention-to-treat. Two authors collected data independently and evaluated quality and results. The datas were quantified by Meta-analysis.Results: 4 RCTs were included. The methodological quality was generally low. Results of Meta-analysis showed that the laparoscopy could have less operative blooding losses(WMD -134.28 ;95%CI -226.64,-41.91),shorten postoperativ recovery times of rectal function (WMD -10.39 ;95%CI -15.12,-5.66)and hospital days (WMD -2.88 ;95%CI -4.36,1.40) than laparotomy,but no significant difference in the number of pelvic(WMD 0.22 ;95%CI -1.32,1.75)and para-aortic lymphectomy (WMD -0.99 ;95%CI -2.48,0.49),and even have longer operative times than laparotomy.There is no significant difference in recurrence rate and overall survival and disease-free survival.It has not been concluded that the objects including recurrence rate(OR 0.74 ;95%CI 0.18,2.97) and overall survival (OS) (OR 0.66 ;95%CI 0.26,1.21) and disease-free survival (DFS)(OR 0.56 ;95%CI 0.22,2.00) are different.Conclusions: The laparoscopy could have less operative blooding loss, shorter times of rectal functional recovery and hospitalization but higher operative times than laparotomy.No significant difference both in the numbers of pelvic and para-aortic lymphectomy and in recurrence rate and Os and DFS.However,the fail-safe numbers(Nfs0.05) of operative blooding loss and postoperative times of rectal function to recover or operative time and hospital days convey that the outcome of this study is stable,which means that publicationbias are small. Although the high methodological quality of the included trials increases the reliance of the outcomes,well-designed clinical trials which cann't be replaced by the Meta analysis should be perfomed to come to the affirmative conclusion.Furthmore,the distant outcomes arised from laparoscopy shoud be observed and evaluated.