A meta-analysis of survival after minimally invasive radical hysterectomy versus abdominal radical hysterectomy in cervical cancer: center-associated factors matter
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Authors
Sun, Si
Cai, Jing
Li, Ruixie
Wang, Yujia
Zhao, Jing
Huang, Yuhui
Xu, Linjuan
Yang, Qiang
Wang, Zehua
Issue Date
2022-01-21
Type
Article
Language
en_US
Keywords
Cervical Cancer , Minimally Invasive Surgery , Laparoscopic Radical Hysterectomy , Robotic-Assisted Radical Hysterectomy , Abdominal Radical Hysterectomy , Oncological Outcome , Overall Survival , Disease-Free Survival , Recurrence
Alternative Title
Abstract
Purpose:
To explore the possible factors that contributed to the poor performance of minimally invasive surgery (MIS) versus abdominal surgery regarding progression-free survival (PFS) and overall survival (OS) in cervical cancer.
Methods:
MEDLINE, EMBASE, Cochrane Library and Web of Science were searched (January 2000 to April 2021). Study selection was performed by two researchers to include studies reported oncological safety. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were combined using random-effect model. Subgroup analyses were stratified by characteristics of disease, publication, study design and treatment center.
Results:
Sixty-one studies with 63,369 patients (MIS 26956 and ARH 36,049) were included. The overall-analysis revealed a higher risk of recurrence (HR 1.209; 95% CI 1.102–1.327) and death (HR 1.124; 95% CI 1.013–1.248) after MIS versus ARH expect in FIGO IB1 (FIGO 2009 staging) patients with tumor size less than 2 cm. However, subgroup analyses showed comparable PFS/DFS and OS in studies published before the Laparoscopic Approach to Cervical Cancer (LACC) trial, published in European journals, conducted in a single center, performed in centers in Europe and in centers with high sample volume or high MIS sample volume.
Conclusion:
Our findings highlight possible factors that associated with inferior survival after MIS in cervical cancer including publication characteristics, center-geography and sample volume. Center associated factors were needed to be taken into consideration when evaluating complex surgical procedures like radical hysterectomy.
Description
Citation
Sun, S., Cai, J., Li, R., Wang, Y., Zhao, J., Huang, Y., Xu, L., Yang, Q., & Wang, Z. (2022). A meta-analysis of survival after minimally invasive radical hysterectomy versus abdominal radical hysterectomy in cervical cancer: center-associated factors matter. Archives of gynecology and obstetrics, 306(3), 623–637. https://doi.org/10.1007/s00404-021-06348-5
Publisher
Archives of Gynecology and Obstetrics