Department of Gynecology and Obstetrics, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
Faculty of Economics and Management, Leibniz University Hannover, Hannover, Germany.
Arch Gynecol Obstet. 2022 Aug;306(2):295-314. doi: 10.1007/s00404-021-06248-8. Epub 2021 Oct 8.
Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery.
Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time.
27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI - 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference - 114.34 [- 122.97; - 105.71]) and RH (mean difference - 287.14 [- 392.99; - 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference - 3.06 [- 3.28; - 2.83]) and RH (mean difference - 3.77 [- 5.10; - 2.44]) compared to AH.
Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials.
根治性子宫切除术和盆腔淋巴结切除术是早期宫颈癌的标准治疗方法。研究表明，开放式手术与微创式手术相比具有更好的肿瘤学结果，但围手术期并发症发生率则相反。本荟萃分析评估了机器人手术、腹腔镜手术与开放式手术相比在围手术期的发病率和并发症。
2020 年 6 月，我们在 Embase 和 Ovid-Medline 数据库中系统地搜索了比较机器人、腹腔镜和开放式根治性子宫切除术的研究。对发表年份没有限制。纳入标准与 LACC 试验相似。根据手术技术、研究设计和出版物日期进行亚组分析，以评估术中及术后发病率、估计失血量、住院时间和手术时间等终点。
27 项研究符合纳入标准。其中包括 5 项前瞻性、随机对照试验。荟萃分析显示，机器人根治性子宫切除术（RH）和腹腔镜子宫切除术（LH）在术中及围手术期并发症方面无显著差异。两种手术的手术时间均长于开放式子宫切除术（RH：平均差值 44.79 分钟 [95%CI 38.16；51.42]；LH：平均差值 20.96 分钟 [95%CI -1.30；43.22]），但并未导致术中及术后并发症增加。LH 组的术中发病率低于 AH 组（RR 0.90 [0.80；1.02]），RH 组也低于 AH 组（0.54 [0.33；0.88]）。LH 组与 RH 组的术中发病率无差异（RR 1.29 [0.23；7.29]）。任何一种方法的术后发病率均无差异。LH 组（平均差值-114.34 [–122.97；–105.71]）和 RH 组（平均差值-287.14 [–392.99；–181.28]）的失血量均低于 AH 组。LH 组（平均差值-3.06 [–3.28；–2.83]）和 RH 组（平均差值-3.77 [–5.10；–2.44]）的住院时间均短于 AH 组。
微创根治性子宫切除术似乎与术中发病率和失血量降低以及术后康复改善有关。在为根治性子宫切除术患者提供咨询时，除了考虑肿瘤学和外科因素外，还应考虑这些结果，并强调需要进行新的随机试验。
