The Clinical Efficacy Of Laparoscopic And Abdominal Surgery In The Treatment Of Early-stage Cervical Cancer: A Meta Analysis

Backgrounds and objections:For early-stage cervical cancer( FIGO stage IA2~IIA), the traditional standard operation method is abdominal radical hysterectomy and pelvic lymphadenectomy(ARH+APL).In recent years, with the continuous improvement of the laparoscopic technology, the early-stage cervical cancer treatment gradually get positive and promotion. However, because of the small number of independent study sample, the follow-up time being not long enough, the high quality of the study being uneven, so far, there is no large sample, high quality, multi-center clinical trial report.To this end, the purpose of this study was to evaluate the effectiveness and safety of laparoscopic radical hysterectomy and pelvic lymphadenectomy( LRH+LPL) and ARH+APL in the treatment of early cervical cancer by using a meta analysis, in order to provide a more reliable basis for the clinical selection of appropriate surgical methods.Methods:Pub Med, MEDLINE, EMBASE, CNKI, VIP, Wan fang database and a manual search of Jilin University Medical Library Literature were searched for related literatures which were published during 2000.01~2015.08 in English and Chinese,including prospective cohort study, retrospective case-control studies and randomized controlled trials.According to the inclusion criteria and the exclusion criteria, the literatures were screened and selected to meet the criteria,and we evaluated all the selected literatures with principles and methods of systematic evaluation introduced by the Cochrane collaboration.Relevant dates extracted were analyzed with Revman5.3.Results:Eventually included 26 related studies involving 3220 patients met the inclusion criteria:1 case of prospective cohort study, 18 cases retrospective case-control studies and 7 randomized controlled studies(RCT), including ten in English, and sixteen in Chinese.The results of meta-analysis showed that: there was no significant difference between LEH and AEH in the length of vaginal edge[SMD=-0.18 95%CI:(-0.38,0.01),P=0.07], the length of parametrium[SMD=0.10 95%CI:(-0.22,0.41),P=0.54], the number of pelvic lymph nodes[SMD=0.23 95%CI:(-0.02,0.48),P=0.07], the intraoperative complication rate[OR=1.11 95%CI:(0.77,1.60),P=0.57]、the postoperative recurrent rate[OR=0.96 95%CI:(0.62,1.49),P=0.87],the postoperative mortality[OR=0.94 95%CI:(0.54,1.63),P=0.84];But there were remarkable significant differences between LEH and AEH in the operation time[SMD=-0.25 95%CI:(-0.76,0.26),P=0.04], intraoperative bleeding[SMD=-1.94 95%CI:(-2.43,-1.45),P<0.00001], the postoperative complication rate[OR=0.46 95%CI:(0.38,0.57),P<0.00001]、 the recovery time of gastrointestinal function by the day[SMD=-1.28 95%CI:(-0.16,-0.97) P<0.00001]、the recovery time of gastrointestinal function by the hour[SMD=-2.18 95%CI:(-3.08,-1.28),P<0.00001],the catheterization time[SMD=-0.44 95%CI:(-0.87,-0.02),P=0.04] the postoperative hospital stay[SMD=-1.18 95%CI:(-1.53,-0.84),P<0.00001].Conclusions:The 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.