Yuan Yuquan, Tan Qin, Chen Yingfan, Zhu Keyang, Pan Bin, Liu Bao, Ren Chunyan, Li Ganghui, Chen Cheng, Zhao Chengzhi
Department of Gynecologic Oncology, Chongqing Health Center for Women and Children, Chongqing, China.
Department of Gynecologic Oncology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Front Oncol. 2025 Jan 15;14:1524991. doi: 10.3389/fonc.2024.1524991. eCollection 2024.
Emerging surgical methods are utilized to treat endometrial cancer. The study aimed to assess the efficacy and safety of four common surgical methods of hysterectomy.
We systematically searched the PubMed, Cochrane Library databases, Medline, EMBASE and Web of Science from their inception until April 30, 2024. We used hazard ratios (HR) for overall survival (OS) and disease-free (DFS), odds ratios (OR) for categorical outcomes, and mean differences (MD) for continuous outcomes with 95% confidence intervals. These were pooled in Bayesian network meta-analysis models. The surface under the cumulative ranking curve (SUCRA) was used to illuminate the probability that each method would be the best for each outcome.
Thirty studies comprising 13446 patients were included. Robotic hysterectomy (RH) retrieved fewer pelvic lymph nodes than open hysterectomy (OH). OH showed a significantly higher postoperative complication rate than laparoscopic hysterectomy (LH) and RH. LH had a higher intraoperative complication rate than OH. According to SUCRA values, OH ranked the highest in the number of retrieved pelvic lymph nodes (0.89), intraoperative complications (0.73), and operative time (0.97). LH ranked the highest in DFS (0.81) and overall survival (OS) (0.87). RH ranked the highest in the postoperative complications (0.95). Laparoscopic-assisted vaginal hysterectomy (LAVH) ranked the highest in number of retrieved para-aortic lymph nodes (0.72).
There are no significant differences among the four surgical methods in DFS or OS. The use of uterine manipulators does not affect prognosis. OH is the best method for shortening operative time, dissecting the pelvic lymph nodes and controlling intraoperative complications. LH and LAVH have an advantage in para-aortic lymph node dissection. Besides, LH has the best advantage in DFS and OS. RH has advantages in controlling surgical complications.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024529974.
新兴的手术方法被用于治疗子宫内膜癌。本研究旨在评估四种常见子宫切除术手术方法的疗效和安全性。
我们系统检索了PubMed、Cochrane图书馆数据库、Medline、EMBASE和Web of Science，检索时间从各数据库建库至2024年4月30日。我们使用总生存（OS）和无病生存（DFS）的风险比（HR）、分类结局的比值比（OR）以及连续结局的均值差（MD）并结合95%置信区间。这些数据被汇总到贝叶斯网络荟萃分析模型中。累积排序曲线下面积（SUCRA）用于阐明每种方法对每种结局而言成为最佳方法的概率。
纳入了30项研究，共13446例患者。机器人子宫切除术（RH）获取的盆腔淋巴结少于开腹子宫切除术（OH）。OH术后并发症发生率显著高于腹腔镜子宫切除术（LH）和RH。LH术中并发症发生率高于OH。根据SUCRA值，OH在获取的盆腔淋巴结数量（0.89）、术中并发症（0.73）和手术时间（0.97）方面排名最高。LH在DFS（0.81）和总生存（OS）（0.87）方面排名最高。RH在术后并发症方面排名最高（0.95）。腹腔镜辅助阴式子宫切除术（LAVH）在获取的腹主动脉旁淋巴结数量方面排名最高（0.72）。
四种手术方法在DFS或OS方面无显著差异。子宫操纵器的使用不影响预后。OH是缩短手术时间、清扫盆腔淋巴结和控制术中并发症的最佳方法。LH和LAVH在腹主动脉旁淋巴结清扫方面具有优势。此外，LH在DFS和OS方面具有最佳优势。RH在控制手术并发症方面具有优势。
