Ioana Jabri Tabrizi Madalina, Voiță-Mekereș Florica, Motofelea Alexandru Catalin, Ciprian Duta, Fulger Lazăr, Alexandru Isaic, Tarta Cristi, Stelian Pantea, Bernad Elena Silvia, Teodora Hoinoiu
Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania.
Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania.
Diagnostics (Basel). 2024 Dec 11;14(24):2782. doi: 10.3390/diagnostics14242782.
BACKGROUND/OBJECTIVES: This systematic review aimed to evaluate the outcomes of minimally invasive techniques in gynecological cancer surgery, specifically laparoscopic hysterectomies (LHs), robotic-assisted hysterectomies (RHs), and laparoscopic-assisted vaginal hysterectomies (LAVHs).
We conducted a comprehensive search of electronic databases including PubMed and MedLine from January 2010 to August 2024. The search included randomized controlled trials (RCTs) and observational studies. Studies were selected based on inclusion criteria such as a focus on LHs, RHs, or LAVHs, and reporting on key outcomes like recovery rates, overall survival (OS) rates, disease-free survival (DFS), postoperative complications, and surgery time. Exclusion criteria were applied to omit non-randomized studies, non-English publications, and those lacking relevant data.
The analysis included 35 studies on gynecological cancers and surgical procedures, conducted across multiple countries. Among them, 8 were RCTs from countries like the Netherlands and Italy, while 20 were retrospective cohort studies from China and the USA. The studies varied in design, cancer type, and participant age, highlighting diverse surgical approaches and the adaptation of minimally invasive techniques in gynecological cancer treatment. LH and RH demonstrated similar oncological safety with comparable OS and DFS rates. RH was associated with reduced blood loss, but longer operative times compared to LH. LAVH showed favorable perioperative outcomes, including shorter hospital stays and faster recovery, but was less frequently studied in advanced-stage cancers. Complication rates were generally lower in minimally invasive surgeries compared to open procedures. The findings support the efficacy of LH and RH as viable alternatives to open surgery, with specific advantages depending on patient and disease characteristics.
Minimally invasive techniques in gynecological cancer surgery offer significant advantages in terms of recovery and complication rates. Despite these benefits, further research is needed to confirm their oncological safety and overall effectiveness compared to traditional open surgeries.
背景/目的：本系统评价旨在评估微创技术在妇科癌症手术中的疗效，特别是腹腔镜子宫切除术（LH）、机器人辅助子宫切除术（RH）和腹腔镜辅助阴道子宫切除术（LAVH）。
我们对2010年1月至2024年8月期间的电子数据库进行了全面检索，包括PubMed和MedLine。检索范围包括随机对照试验（RCT）和观察性研究。根据纳入标准选择研究，如聚焦于LH、RH或LAVH，并报告关键结局，如恢复率、总生存率（OS）、无病生存率（DFS）、术后并发症和手术时间。应用排除标准排除非随机研究、非英文出版物以及缺乏相关数据的研究。
分析纳入了35项关于妇科癌症和手术程序的研究，这些研究在多个国家开展。其中，8项是来自荷兰和意大利等国的RCT，20项是来自中国和美国的回顾性队列研究。这些研究在设计、癌症类型和参与者年龄方面存在差异，突出了不同的手术方法以及微创技术在妇科癌症治疗中的应用。LH和RH在肿瘤学安全性方面表现相似，OS和DFS率相当。与LH相比，RH出血量减少，但手术时间更长。LAVH围手术期结局良好，包括住院时间缩短和恢复更快，但在晚期癌症中的研究较少。与开放手术相比，微创手术的并发症发生率总体较低。研究结果支持LH和RH作为开放手术的可行替代方案的有效性，具体优势取决于患者和疾病特征。
妇科癌症手术中的微创技术在恢复和并发症发生率方面具有显著优势。尽管有这些益处，但与传统开放手术相比，仍需进一步研究以确认其肿瘤学安全性和总体有效性。
