Complications, recurrence, and survival rates for endometrial and cervical cancer treated by minimally invasive surgery: a systematic review and meta-analysis of randomised controlled trials
TL;DR
Bladder and vaginal injuries are higher with minimally invasive compared to abdominal hysterectomy and survival rates for endometrial cancer, minimally invasive hysterectomy is associated with poorer survival outcomes and this should be taken into account when counselling patients and deciding upon the route of hysterectomy.
Abstract
Background Consensus is lacking regarding the relative safety and oncological outcomes of minimally invasive compared to abdominal hysterectomy. Objectives To estimate complications and survival rates of minimally invasive hysterectomy (MIH) (i.e., laparoscopic or robotic assisted) compared to total abdominal hysterectomy (TAH) for endometrial and cervical cancer. Methods A systematic quantitative review of randomised controlled trials (RCTs) comparing MIH with TAH for the treatment of endometrial or cervical cancer. Medline-PubMed, Cochrane Library, Scopus, ongoing clinical trials and the grey literature were searched until December 1, 2024. Main Outcome Measures Complications, overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates. Results Twenty-nine RCTs enrolling 6,127 patients were included. The risk of bladder injury was higher in the MIH group [risk ratio (RR): 1.84, 95% confidence interval: (CI): 1.03-3.29, I2: 0%), as was the risk of vaginal injury (RR: 12.39, 95% CI: 1.61-95.29, P=0.02, I2: 0%) but the risk of wound dehiscence was lower (RR: 0.32, 95% CI: 0.13-0.83, P=0.02, I2: 13%) compared to abdominal hysterectomy. Among cervical cancer patients, the risk for blood transfusion was significantly lower with the MIH (RR: 0.42, 95% CI: 0.21-0.84, P=0.01, I2: 0%). Among endometrial cancer patients, the OS, DFS, and DSS were comparable between routes of hysterectomy. In contrast, the overall the OS and DFS rates were lower for minimally invasive compared to abdominal hysterectomy (0.94, 95% CI: 0.90-0.98, P=0.005, I2:0 %) and (0.89, 95% CI: 0.84-0.94, P<0.001, I2: 0%) respectively. Conclusions Bladder and vaginal injuries are higher with minimally invasive compared to abdominal hysterectomy. Survival rates for endometrial cancer are comparable but for cervical cancer, minimally invasive hysterectomy is associated with poorer survival outcomes and this should be taken into account when counselling patients and deciding upon the route of hysterectomy. What is New? TAH has superior survival outcomes compared to minimally invasive hysterectomy.