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Disease-Free and Survival Outcomes for Total Laparoscopic Hysterectomy Compared With Total Abdominal Hysterectomy in Early-Stage Endometrial Carcinoma: A Meta-analysis
  1. Rebecca Asher, MSc*,
  2. Andreas Obermair, MD, FRANZCOG, CGO,
  3. Monika Janda, PhD and
  4. Val Gebski, MStat*
  1. * National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales; and
  2. Queensland Centre for Gynaecological Cancer and School of Medicine, the University of Queensland; and
  3. School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
  1. Address correspondence and reprint requests to Rebecca Asher, MSc, National Health and Medical Research Council Clinical Trials Centre, Level 5, Bldg F, 92-94 Parramatta Rd, Camperdown, New South Wales 2050, Australia. E-mail: rebecca.asher{at}ctc.usyd.edu.au.

Abstract

Objectives Laparoscopic hysterectomy is currently offered to a large number of patients, and assessing the noninferiority to abdominal hysterectomy with respect to clinical outcomes is key. We examine rates of recurrence, disease-free survival (DFS), and overall survival, and surgical complications of laparoscopic compared with abdominal hysterectomy for the treatment of early-stage endometrial cancer.

Methods Electronic databases were systematically searched to identify relevant studies, and patient characteristics and clinical outcomes extracted. The primary outcome was 3-year DFS, and estimates were pooled using an inverse-variance weighted meta-analysis.

Results Nine studies (4405 patients) were identified in which DFS was reported in 5 studies. The difference in 3-year DFS was 1.44% (95% confidence interval [CI], −0.65% to 3.53%) in favor of total abdominal hysterectomy, consistent with a noninferiority margin of 5%. Differences in DFS (hazard ratio, 1.10; 95% CI, 0.92–1.32), overall survival (hazard ratio, 1.16; 95% CI, 0.81–1.66), and local recurrence (difference, 0.42%; 95% CI, −0.41% to 1.25%) were not significant. Rates of intraoperative complications showed no difference (0.5%; 95% CI, −1.1% to 2.0%) based on 7 studies. There was a significant reduction in postoperative complications with the laparoscopic procedure (−6.83%; 95% CI, −9.19% to −4.47%).

Conclusions Noninferiority of laparoscopy was demonstrated on clinical outcomes and was associated with a reduction in postoperative complications. These results support continued treatment by laparoscopic hysterectomy for early-stage endometrial cancer.

  • Disease-free survival
  • Endometrial cancer
  • Meta-analysis
  • Noninferiority
  • Total abdominal hysterectomy
  • Total laparoscopic hysterectomy

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Footnotes

  • The authors declare no conflicts of interest.

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