Laparoscopically assisted versus open surgery for endometrial cancer--a meta-analysis of randomized controlled trials

There is no clear consensus on the advantages of laparoscopically assisted surgery (LAS) versus open surgery (OS) for endometrial cancer. The present study compared LAS versus OS for patients with endometrial cancer with regard to operative parameters and outcomes. A search of the PubMed, EMBASE, the China Biological Medicine Datadase (CBMdisc), Ovid, and the Cochrane Library identified four studies that met the inclusion criteria for data extraction. Estimates of effectiveness were performed using fixed- and random effects models. The effect was calculated as an odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals (CIs). Level of significance was set at P < 0.05. Outcomes of 331 patients were studied. When randomized controlled trials were analyzed, OR for LAS was 0.34 (95% CI: 0.13, 0.89; P = 0.03) for postoperative complications and 0.14 (95% CI: 0.05, 0.39; P = 0.0002) for incidence of transfusion; and WMD for LAS was 263.58 mL (95% CI: 467.71, 59.45 mL; P = 0.01) for blood loss, 38.09 min (95% CI: 10.50, 65.68 min; P = 0.007) for operation time, and 3.35 days (95% CI: 3.84, 2.86 days; P < 0.00001) for hospital stay. There was no difference in patients in terms of recurrence and survival. The present study has shown that LAS was associated with fewer postoperative complications, lower incidence of transfusion, less blood loss, longer operation time, and shorter hospital stay. What's more, no significant difference was found in terms of recurrence and survival. When performed by suitably specialized surgeons in selected patients, it appears to be a better choice than OS.