Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open...

Area of Science:

• Gynecologic Oncology
• Surgical Innovation
• Evidence Synthesis

Background:

• Minimally invasive surgery (MIS) is the standard for early-stage endometrial cancer (EC).
• Previous reviews focused only on randomized controlled trials (RCTs), excluding valuable non-randomized data.
• This study provides a comprehensive comparison of MIS versus open surgery for early EC using all study designs.

Purpose of the Study:

• To systematically review and network meta-analyze clinical and oncological outcomes of MIS versus open surgery for early EC.
• To compare laparoscopic surgery and robotic-assisted surgery against each other and against open surgery.
• To incorporate evidence from both randomized and non-randomized studies.

Main Methods:

• Systematic review and Bayesian network meta-analysis.
• Inclusion of all experimental designs from English-language peer-reviewed articles (1995-2021).
• Analysis of 99 studies involving 181,716 women across 14 outcomes.

Main Results:

• Laparoscopic and robotic surgery reduced blood loss and hospital stay but increased operating time compared to open surgery.
• Robotic surgery showed significantly lower rates of ileus and intra-operative complications versus laparoscopic surgery.
• Robotic surgery was associated with higher disease-free survival compared to laparoscopic surgery.

Conclusions:

• Minimally invasive surgery (robotic-assisted and laparoscopic) is safer and more efficacious than open surgery for early endometrial cancer.
• Robotic-assisted surgery demonstrates superior outcomes regarding complications and disease-free survival.
• This comprehensive analysis supports MIS, particularly robotic approaches, for early EC treatment.