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Oncologic outcomes of minimally invasive versus open radical hysterectomy for early stage cervical carcinoma and tumor size <2 cm: a systematic review and meta-analysis
  1. Dimitrios Nasioudis1,
  2. Benjamin B Albright2,
  3. Emily M Ko1,
  4. Ashley F Haggerty1,
  5. Robert L Giuntoli II1,
  6. Sarah H Kim1,
  7. Mark A Morgan1 and
  8. Nawar A Latif1
  1. 1Division of Gynecologic Oncology, Penn Medicine, Philadelphia, Pennsylvania, USA
  2. 2Division of Gynecologic Oncology, Duke University, Durham, North Carolina, USA
  1. Correspondence to Dr Dimitrios Nasioudis, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia 19104, Pennsylvania, USA; dimitrios.nasioudis{at}uphs.upenn.edu

Abstract

Objective To investigate the oncologic outcomes of patients with early-stage cervical carcinoma and tumor size <2 cm who underwent open or minimally invasive radical hysterectomy.

Methods The Pubmed/Medline, Embase, and Web-of-Science databases were queried from inception to January 2021 (PROSPERO CRD 42020207971). Observational studies reporting progression-free survival and/or overall survival for patients who had open or minimally invasive radical hysterectomy for early-stage cervical carcinoma and tumor size <2 cm were selected. Level of statistical heterogeneity was evaluated with the I2 statistic. A random-effects model was used to compare progression and overall survival between the two groups and HR with 95% confidence intervals were calculated with the Der Simonian and Laird approach. Risk of bias and quality of included studies was assessed with the Newcastle-Ottawa scale.

Results A total of 10 studies that met the inclusion criteria were included encompassing 4935 patients. Of these, 2394 (48.5%) patients had minimally invasive and 2541 (51.5%) patients had open radical hysterectomy; respectively. Patients who underwent minimally invasive hysterectomy had worse progression-free survival than those who had open surgery (HR 1.68, 95% CI 1.20, 2.36, I2 26%). Based on five studies, patients who had minimally invasive (n=1808) hysterectomy had a trend towards worse overall survival than those who had open surgery (n=1853) (HR 1.64, 95% CI 1.00 to 2.68, I2 15%).

Conclusion Based on a systematic review of the literature and meta-analysis of studies that control for confounders, for patients with cervical cancer and tumor size <2 cm, minimally invasive radical hysterectomy was associated with worse progression-free survival than laparotomy.

  • cervical cancer
  • laparoscopes
  • laparotomy

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @BenAlbrightMD

  • Contributors DN: Conceptualization; data curation; statistical analysis; formal analysis; investigation; methodology; project administration; resources; software; visualization; writing - original draft; writing - review and editing. BBA: Data curation; formal analysis; investigation; methodology; project administration; resources; software; visualization; writing - original draft; writing - review and editing. SK, MM, RLG II, AFH, EMK: Investigation; methodology; writing - original draft; writing - review and editing. NL: Supervision; formal analysis; investigation; methodology; writing - original draft; writing - review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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