Radical Hysterectomy with Preoperative Conization in Early-stage Cervical Cancer: A Systematic Review and Pairwise and Network Meta-analysis

Abstract

Objective

The investigation of the role of preoperative conization in cervical cancer aiming to explore its potential clinical significance.

Data sources

Cochrane Library, EMBASE, PubMed and Web of Science, up to April 28, 2023.

Methods of Study Selection

(1) Observational cohort studies (2) Studies comparing radical hysterectomy with preoperative conization versus non-preoperative conization in patients with early-stage cervical cancer, and (3) Studies comparing disease-free survival outcomes. Tabulation, Integration and Results Two reviewers independently extracted the data and assessed the quality of the studies. The meta-analysis employed combined hazard ratios (HR) along with their corresponding 95% confidence intervals (CI) to compare radical hysterectomy with preoperative conization (CO) and radical hysterectomy without preoperative conization (NCO). We conducted a Bayesian network meta-analysis using Markov Chain Monte Carlo (MCMC) methods to compare: 1. Minimally invasive radical hysterectomy with preoperative conization (MC) and 2. Open radical hysterectomy with preoperative conization (OC) and 3. Minimally invasive radical hysterectomy without preoperative conization (MNC) and 4. Open radical hysterectomy without preoperative conization (ONC).

Results

Our study included 15 retrospective trials, 10 of which were used to traditional pairwise meta-analysis and eight for network meta-analysis. The radical hysterectomy without preoperative conization group exhibited a notably higher probability of cancer recurrence than the radical hysterectomy with preoperative conization group (HR 0.52, 95% CI 0.41-0.65). In the network meta-analysis, minimally invasive radical hysterectomy without preoperative conization showed the worst survival outcome.

Conclusions

Preoperative conization appears to be a protective factor in decreasing recurrence risk, assisting clinicians in predicting survival outcomes for patients with early-stage cervical cancer. It may potentially aid in selecting suitable candidates for minimally invasive surgery in clinical practice.