Laparoscopic Radical Hysterectomy For Cervical Cancer: A Meta-analysis

Objective: To assess the efficacy and safety of laparoscopic radical hysterectomy(LRH) for cervical cancer.Methods: We searched The Cochrane Library(Issue04, 2014), PubMed, EMbase, CBM,CNKI, VIP, WanFang Data(from inception to April, 2014), by using computer, and searched related journals by hand. And we collected all relevant randomized controlled trials(RCTs) on LRH versus abdominal radical hysterectomy(ARH) in the treatment of cervical cancer.Meanwhile, these RCTs were identified according to the inclusion and exclusion criteria, data were extracted, and the methodological quality of included studies was accessed by two reviewers independently. Meta-analysis was then performed using RevMan 5.2 software.Results: Seven RCTs involving 462 patients were 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<0.00001; SMD=-1.54, 95%CI-2.92 to-0.16,P=0.03; MD=-1.37, 95%CI-1.85 to-0.89, P<0.00001; MD=-2.32, 95%CI-3.57 to-1.06, P=0.0003; RR=0.42, 95%CI 0.18 to 0.97, P=0.04). But there was no significant difference in number of lymph node biopsy(MD=1.34, 95%CI-4.26 to 6.94, P=0.64) and some operative complications(lymphocyte: pooled RR=1.19, 95%CI 0.54 to 2.63, P=0.66;DVT: pooled RR=1.23,95%CI 0.48 to 3.20, P=0.67; urinary retention: pooled RR=0.85, 95%CI 0.41 to 1.75, P=0.66;cystotomy: pooled RR=1.91, 95%CI 0.49 to 7.51, P=0.35).Conclusion: Meta-analysis showed that although LRH has a longer time, requires high level of technology, it is much safer and effective than ARH. Its long-term efficacy still needs more high-quality, multi-center large sample randomized controlled clinical trial studies to be further confirmed.