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Survival outcomes of robotic-assisted laparoscopy versus conventional laparoscopy and laparotomy for endometrial cancer: A systematic review and meta-analysis

医学 子宫内膜癌 危险系数 剖腹手术 荟萃分析 内科学 肿瘤科 置信区间 CLs上限 腹腔镜检查 妇科 癌症 外科 验光服务
作者
Hanlin Fu,Jiahui Zhang,Shiyi Zhao,Nannan He
出处
期刊:Gynecologic Oncology [Elsevier]
卷期号:174: 55-67 被引量:13
标识
DOI:10.1016/j.ygyno.2023.04.026
摘要

ObjectiveRobotic-assisted laparoscopy (RALS) has gained widespread acceptance in the field of gynecological oncology. However, whether the prognosis of endometrial cancer after RALS is superior to conventional laparoscopy (CLS) and laparotomy (LT) remains inconclusive. Therefore, the aim of this meta-analysis was to compare the long-term survival outcomes of RALS with CLS and LT for endometrial cancer.MethodsA systematic literature search was conducted on electronic databases (PubMed, Cochrane, EMBASE and Web of Science) until May 24, 2022, followed by a manual search. Based on inclusion and exclusion criteria, publications investigating long-term survival outcomes after RALS vs CLS or LT in endometrial cancer patients were collected. The primary outcomes included overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS) and disease-free survival (DFS). Fixed effects models or random effects models were employed to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) as appropriate. Heterogeneity and publication bias were also assessed.ResultsRALS and CLS had no difference in OS (HR = 0.962, 95% CI: 0.922–1.004), RFS (HR = 1.096, 95% CI: 0.947–1.296), and DSS (HR = 1.489, 95% CI: 0.713–3.107) for endometrial cancer; however, RALS was significantly associated with favorable OS (HR = 0.682, 95% CI: 0.576–0.807), RFS (HR = 0.793, 95% CI: 0.653–0.964), and DSS (HR = 0.441, 95% CI: 0.298–0.652) when compared with LT. In the subgroup analysis of effect measures and follow-up length, RALS showed comparable or superior RFS/OS to CLS and LT. In early-stage endometrial cancer patients, RALS had similar OS but worse RFS than CLS.ConclusionsRALS is safe in the management of endometrial cancer, with long-term oncological outcomes equivalent to CLS and superior to LT.
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