Clinical Effectiveness And Safety Of Laparoscopy Versus Laparotomy For Endometrial Cancer:a Meta-analysis

Objective:To assess the clinical effectiveness and safety of laparoscopic operation versus laparotomy for the treatment of endometrial cancer. Methods: The databases such as The Cochrane Library, PubMed, EMBASE, OVID, CNKI, Wanfang database, CNKI, VIP and CBM were searched to collect randomized control trials (RCTs) about the clinical effectiveness and safety of laparoscopic operation and laparotomy for the treatment of endometrial cancer From1998to September2012. Literatures were screened according to the inclusive and exclusive criteria, the data were extracted, the methodological quality of the included studies was assessed in line with Cochrane Handbook5.1.0,and Meta-analysis was performed by using RevMan5.1soft ware. Results:Ten RCTs involving6993patients were included.Meta-analysis showed that compared with laparotomy, laparoscopic surgery’s operation time is longer than laparotomy, but its intraoperative blood loss was less than laparotomy; its haemoglobin decline from presurgery to the firstday after surgery was lower;the time of post-operative intestinal gas exhaust and the length of hospital stay was shorter.Regarding the number of pelvic and para-aortic lymph nodules removed,there was no difference between the2groups.Regarding operative complications, the occurrence rate of intraoperative complications of laparotomy may lower than laparoscopy,for example Vaginal injury,but estimated blood loss exceeding500ml of intraoperation was higher, ntraoperative bowel,bladder,uretheral and vascular injury were no difference;but postoperative complications may higher than laparoscopy.for instance ileus and wound dehiscence and infection,but urinary tract infection, hemorrhage\hematoma, fever>38℃,vein thrombosis and lymphedema/lymphocyst were no difference between the2groups.After surgery in follow-up3to5years, recurrence rate,mortality and disease-free survival rate showed no difference. Conclusion:Compared laparoscopy with laparotomy. operation time of laparoscopy was longer; the blood loss and the haemoglobin decline from presurgery to the firstday after surgery were lower; the time of postoperative intestinal gas exhaust and the length of hospital stay were shorter; the occurrence rate of intraoperative estimated blood loss exceeding500mL was lower, and laparoscopic occurrence rate of postoperative complications was low,for instance ileus and wound dehiscence and infection;however, the occurrence rate of intraoperative complications was high, for example Vaginal injury; in addition, the number of pelvic and para-aortic lymph nodules removed were similar; the occurrence rate of intraoperative bowel,bladder,uretheral and vascular injury were similar;the occurrence rate of postoperative urinary tract infection. hemorrhage\hematoma, fever>38℃,vein thrombosis and lymphedema/lymphocyst were similar;After surgery in follow-up3to5years, recurrence rate,mortality and disease-free survival rate were similar between the2groups. The above conclusion is not still can not replace the results of the study which is high-quality,large sample,the multi-center, randomized and double-blind.