Comparison Of Robotic-assisted Laparoscopy,Traditional Laparoscopy And Laparotomy Surgery Of In The Treatment Of Endometrial Carcinoma:A Network Meta Analysis

Objective:The efficacy of robotic-assisted laparoscopy surgery(RAS),traditional laparoscopy(LPS)and laparotomy surgery(LPT)in endometrial carcinoma was compared by means of network meta-analysis,with a view to providing a reference for endometrial carcinoma patients and clinicians.Methods:A computerized search of the Chinese and English literature on endometrial carcinoma surgery performed by the three surgical procedures was conducted in databases ranging from CNKI,Wanfang,Wipu,Sinomed,Pumbed,Web of Science,The Cochrane Library,to Embase,from the time of the database construction to July2022.Outcome incidents included operative time,estimated blood loss,length of hospital stay,transfusion rate,complication rate(intraoperative,postoperative,total complications),number of lymph nodes removed(pelvic,para-aortic lymph nodes),recurrence rate,5-year disease-free survival rate,5-year overall survival rate.Having thoroughly filtered literature,eligible literature was evaluated for quality and,finally,a network meta-analysis was performed using stata16.0MP.Results:Thirty-six papers,including four randomized controlled trials and 32 cohort studies,13 in Chinese and 23 in English,with a total of 6541 cases of endometrial carcinoma patients,were subsequently enrolled.The results of the network meta-analysis were as follows:(1)Operative time: there was no statistical significance among the three types of surgical procedures,and the SUCRA ranking was: LPT > LPS > RAS;(2)Estimated Blood Loss,Length of Hospital Stay,Transfusion Rate,Total Complications rate:compared with LPT,RAS and LPS had better results and were statistically significant;the difference between RAS and LPS was not statistically significant;SUCRA was ranked as RAS > LPS > LPT;(3)Intraoperative Complication Rate: the intraoperative complication rate of RAS was remarkably lower than that of LPT,while the differences between RAS and LPS,LPS and LPT were not statistically significant;SUCRA was ranked as RAS > LPS > LPT;(4)Postoperative Complication Rate: SUCRA was ranked as RAS > LPS > LPT,and the pairings were statistically significant.(5)Number of Pelvic Lymph Nodes Removed: there was no statistical significance between the three surgical methods;SUCRA was ranked as LPS > LPT > RAS;(6)Number of Para-aortic Lymph Nodes Dissection: there was no statistical significance between the three surgical methods;SUCRA was ranked as RAS > LPS > LPT;(7)Recurrence Rate: there was no statistical significance among the three surgical methods;SUCRA was ranked as LPS > RAS > LPT;(8)5-year Disease-free Survival Rate: there was no significant difference among the three surgical methods;SUCRA was ranked as LPT > LPS > RAS;(9)5-year Overall Survival Rate: there was no significant difference among the three surgical methods;SUCRA was ranked as RAS > LPT > LPS.Conclusion:There were no significant differences among RAS,LPS,and LPT in terms of operation time,number of lymph nodes removed,recurrence rate,5-year disease-free survival rate,and 5-year overall survival rate for endometrial cancer;however,both RAS and LPS showed improvement in intraoperative bleeding,postoperative hospital stay,transfusion rate and complication rate,in which RAS was more effective.