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2022-RA-156-ESGO Minimally invasive versus open abdominal approaches for early-stage cervical and endometrial cancer: a meta-analysis of prospective randomised controlled trials (RCTs)
  1. Inès Ongenda1,2 and
  2. Léa Leufflen3
  1. 1University of Exeter Medical School, Exeter, UK
  2. 2World Bank Group, Washington, DC, DC
  3. 3Private Practice, Lyon, France


Introduction/Background To investigate if minimally invasive surgical techniques lead to higher disease-specific mortality and all-cause mortality at 4.5 years for patients with early-stage cervical and endometrial cancer.

Methodology PubMed/Medline and EMBASE were searched for results from inception to 2021. Prospective randomised controlled trials reporting disease-specific mortality and all-cause mortality at 4.5 years for patients who had minimally invasive or open procedures for early-stage cervical cancer (< II) or endometrial cancer (< III) were selected. Stata 17 was used to conduct a random-effects meta-analysis generating relative risk estimates, odds ratios and 95% CIs. Heterogeneity was examined, small-study effects (Egger’s test), publication bias and study quality (RoB2) assessments were performed.

Results Seven randomised clinical trials between 2001 and 2020 including 4320 patients from 7 countries were included. Two RCTs for cervical cancer and five RCTs for endometrial cancer were selected. Of these, 2584 (60%) patients had minimally invasive surgery, and 1736 (40%) patients had open abdominal surgery. The non-statistically significant risk of all-cause mortality was 18% higher (RR 1.18, 95% CI 0.80, 1.76, I250.5%) and of disease-specific mortality was 26% higher for patients who underwent minimally invasive surgery compared to open abdominal surgery (RR 1.26, 95% CI 0.83, 1.89, I221.4%). However, p = 0.403 (all-cause mortality) and p = 0.265 (disease-specific mortality) indicated little evidence against the null hypothesis. There were no small study effects, little evidence of publication bias and study quality was generally high.

Conclusion Based on a systematic review of the literature and meta-analysis of prospective randomised-controlled trials for patients with early-stage cervical and endometrial cancer, minimally invasive surgery could be associated with a non-significant higher risk of all-cause mortality (18%) and disease-specific mortality (26%) at 4.5 years compared to open abdominal surgery. However, as p > 0.05 and the CI included 1, this meta-analysis was inconclusive.

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