The System Evaluation Of The Safetyand Effectiveness Of Laparoscopic Surgeryand Abdominalsurgery For Cervicalcancer

Objective To assess the effectiveness and safety between totallaparoscopic radical hysterectomy(TLRH),laparoscopic-assisted radicalvaginal hysterectomy(LAVRH) and radical abdominal hysterectomy(RAH)in the treatment of cervical cancer,in order to guide a reasonable choose inclinical.Methods According to the search strategy made by CochraneCollaboration,we searched EMbase(1974to Dec.2011)，MEDLINE(1974toDec.2011),CBM(1979to Dec.2011), CNKI(1979to Dec.2011), the ChineseVIP database(1989to Dec.2011),by using computer, and searched relatedjournals by hand, such as Journal of Practical Obstetrics andGynecology(1986to Dec.2011),Chinese Journal of Obstetrics andGynecology(1982to Dec.2011),Progress In Obstetrics andGynecology(1994to Dec.2011).We indentified randomized controlledtrials,cohort study and controlled clinical trial which compared theeffectiveness and safety between LRH and RAH or among the threeoperation methods for cervical cancer.Two reviewers complete the data extraction and quality assessment independently with cross-checking.RevMan5.1software was used for meta-analysis.Results Acquired8literatures for TLRH compared to RAH,7literatures for LARVH compared to RAH.We can’t obtain the relevantliteratures of comparison between TLRH and LARVH.Generally,15studiesinvolving1848patients.There were806cases in LRH group and1042cases in RAH group were obtained,ultimately,4RCTs,1cohort study and10CCTs.1trial had A level by literature methodological quality level,3Blevel. The results showed that:1.TLRH and RAH:TLRH group had lessblood loss[WMD=-144.94,95%CI (-187.63,-102.25)] and lesspostoperative complications[OR=0.44,95%CI (0.32,0.61)],shorterpostoperative hospitalization time[WMD=3.56,95%CI (4.59,2.53)] andbowel function recovery time[WMD=21.39,95%CI (34.95,7.83)],had alighter postoperative pain trend;No statistically significant differences werefound in operation time, resection lymph node number,intraoperativecomplications, the recurrence rate compared with RAH;the time ofpostoperative bladder functional recovery had different conclusion.2.LARVH and RAH: LARVH can reduce blood loss[WMD=157.83,95%CI(257.69,57.98)]and shorten the postoperative hospitalizationtime[WMD=3.88,95%CI (5.90,1.85)];No statistically significantdifferences were found in operating time,intraoperative and postoperativecomplications,resection lymph node number incidence,the recurrence rate;LARVH can increase the intraoperative complications[OR=3.30,95%CI (1.64,6.63)];the anal exhaust time,bladder function recovery timeand postoperative pain had different conclusion.Conclusion Laparoscopy was a useful and safe choice to treat cervicalcancer.TLRH had the advantages of smaller trauma, less postoperativecomplications, quicker recovery,and lighter pain,TLRH lymph noderemoval can reach the effect of abdominal surgery,and the recurrence ratewas similar to abdominal surgery,and did not increase the time andintraoperatie complications,there was no evidence showed TLRH hadaffect at the recovery time of postoperative bladder function.LARVH hadthe advantages of smaller trauma,shorter postoperative hospitalizationtime,LARVH lymph node removal can reach the effect of abdominalsurgery,and the recurrence rate was similar to the abdominal surgery,anddid not increase the time and postoperative complications,but slightlyhigher intraoperative complication rate,there was no enough evidence ofthe influence of postoperative bowel function and bladder functionrecovery time and postoperative pain.Need more Clinical contrast researchof comparison between laparoscopic surgery and laparoscopic-assistedsurgery. More high quality researchs were needed to strength the evidence.