Laparoscopic treatment of endometrial cancer: systematic review

The objective of this review was to assess the efficacy and safety of laparoscopy compared with laparotomy for treatment of endometrial cancer. Trials were identified by searching the Cochrane Gynecological Cancer Collaborative Review Group Trial Register, MEDLINE, EMBASE, PubMed, BIOSIS Previews, the China Biological Medicine Database, China National Knowledge Infrastructure Whole Article Database, Wan Fang Data, and VIP Information, from January 1991 to May 2012, as well as the Cochrane Central Register of Controlled Trials (Cochrane Library, issue 5, 2012). We also hand searched unpublished and gray literature, reference lists of identified studies, gynecologic cancer handbooks, and conference abstracts. All randomized controlled trials (RCTs) comparing laparoscopic surgery with laparotomy for treatment of all stages of endometrial cancer were selected. Data extraction was performed independently by 2 review authors who assessed study quality and extracted data. The whole articles were assessed for method quality by using the Cochrane Collaboration Back Review Group method quality criteria. Heterogeneity between studies was assessed using the I2 statistic, which estimates the percentage of heterogeneity between trials. The outcomes were pooled statistically when no clinical heterogeneity was apparent. For time to event data, hazard ratios were pooled using the generic inverse variance facility of RevMan 5. Random effects models were used for all meta-analyses. The search yielded 9 eligible RCTs (1361 laparotomy and 2255 laparoscopy). There was no significant difference between laparoscopic and laparotomic approaches to endometrial cancer in 3-year overall survival (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.49 to 1.71; p = .77), 3-year disease-free survival (OR, 0.95; 95% CI, 0.29 to 1.80; p = .89), recurrence at 3-year follow-up (OR, 1.11; 95% CI, 0.60 to 2.06; p = .74), and pelvic node yield (mean difference [MD, 0.45; 95% CI, -0.41 to 1.32; p = .30). The benefits of laparoscopic surgery vs laparotomy were shorter length of hospital stay (MD, -3.42; 95% CI, -3.81 to -3.03; p < .01), and lower rates of postoperative complications (OR, 0.62; 95% CI, 0.52 to 0.73; p < .01). Disadvantages were higher rates of intraoperative complications (OR, 1.35; 95% CI, 1.05 to1.74; p = .02) and longer duration of surgical procedures (MD, 32.73; 95% CI, 16.34 to 49.13; p < .01). We conclude that, compared with laparotomy, laparoscopic surgery seems to be beneficial in women with endometrial cancer, in particular insofar as postoperative complications and length of hospital stay. However, more well-designed RCTs are needed to assess the long-term clinical outcomes, in particular the quality of life.