Meta Analysis Of Clinical Value In The Laparoscopic Surgery Of Cervical Cancer

BACKGROUD:Cervical caner of the uterus is the second common gynecological malignancies in the world, only behind the breast cancer, and it is the most common in China. In the nearly50years, the patients have very obvious tendency to younger and the trend through inland area to the southeast coastal areas, simultaneously through rural patient to white-collar women. Cervical cancer can be diagnosed through cervical cytology and HPV virus-checking in the early stage. Although the staging of cervical cancer is still controversial, normally the clinical stage is used to guide treatmeat. In the recent20years, the younger of cervical cancer patients and the improved early diagnosis rates have Promoted the development of cervical cancer treatment. Radiotherapy is still the major but now concurrent chemotherapy and radiotherapy is also advocated. The laparoscopy, transvaginal or transabdominal surgery can be choosed. At the same time, the application of neoadjuvant chemotherapy provides surgery opportunities for some young inoperable patients at past time. So the clinical therapeutic purposes is not limited to prolong survival. The main treatment of cervical cancer is radical hysterectomy excision and lymph node resection, or pelvic radiotherapy or with chemotherapy Although surgery and radiotherapy are equally effective in patients with early stage cervical cancer, Radiotherapy have adverse effects on ovarian function and vaginal integrity, and plus the long-term sequelae of radiotherapy, patients with early cervical cancer is the preferred surgical treatment. At the same time, patients with pelvic lymph node metastases or other risk factors are recommended that postoperative adjuvant radiotherapy and chemotherapy. In the epidemiological data of the screening system that has been established both developed and developing countries show Invasive cervical cancer incidence and mortality rates have fallen significantly.New demands, how to retain function and to improve the treatment quality of life, is raised. Especially since the1989Querleu created the sugery approach of laparoscopic pelvic lymph node dissection, the patient has an increasing demand for minimally invasive treatment of cervical cancer. However, the feasibility and clinical value of laparoscopic surgical treatment of cervical cancer is still worth investigated.OBJECTIVES:Systematic evaluation of the feasibility and clinical value of laparoscopic surgical treatment of cervical cancer, especially for young patients.MATERIALS AND METHODS:We collected all the domestic and abroad articles about the laparoscopic surgery of Cervical cancer through the computer. The limited time is to the end of2011. And clinical data will be used to summary and meta-analysis. The database include Pubmed, Medline, CNKI, and CBM, ect. In the library of Shandong University, we retrieve all the articles and evaluate, selecte, check and analyze them. At last, Review manager,4.2software is used to meta-analysis the last included articles. THE INCLUSION CRITERIA:Randomized controlled trials (RCT); cervical cancer diagnosed by pathological examination; Clinical stage of cervical cancer (FIGO stage,2009);The treatment group were treated by laparoscopic surgery; The control group were treated by abdominal or vaginal surgery.DATA COLLECTION AND ANALYSIS:The data was collected and analyzed by one operator.RESULTS:Comprehensive systematic literature search conducted according to the search strategy, and through reading titles、abstracts, we preliminary screen the documents and totally get61documents. Through reading the full documents, and according to inclusion criteria, totally3English documents and2Chinese documents are included. Meta analysis on the included documents was conducted by means of Review Manager4.2sofeware. And the final results is expressed in the form of a forest plot and funnel plot. The final conclusions as following:1. Meta-analysis results showed that the laparoscopic group and the laparotomy group have no significant difference at operative time, and blood loss.2. Meta-analysis forest plot, and funnel plot show that the laparotomy group is more effective in the lymph node dissection and laparoscopic groups can shorten the length of hospital stay.CONCLUSIONS:Laparoscopic surgical treatment of cervical cancer can shorten the patients hospital stay; but the laparotomy group has advantage on the lymph node dissection. Compared with laparotomy group, the laparoscopic group has not obvious advantage on operative time and intraoperative blood loss. However, the number and the quality of the included document are not high, and the proof of these documents is so weak, people need to carry out more high-quality research to do further study...