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Peritoneal carcinomatosis after minimally invasive surgery versus open radical hysterectomy: systematic review and meta-analysis
  1. Jorge Hoegl1,
  2. David Viveros-Carreño2,3,
  3. Tatiana Palacios4,
  4. Andres Gallego - Ardila5,
  5. Jose Alejandro Rauh-Hain6,
  6. Erick Estuardo Estrada7,
  7. Florencia Noll8,
  8. Kate Krause9,
  9. Glauco Baiocchi10,
  10. Lucas Minig11,
  11. Carlos Fernando Grillo - Ardila12,13 and
  12. Rene Pareja2,14
  1. 1Obstetrics and Gynecology. Division of Gynecological Oncology, Hospital General del Este "Dr. Domingo Luciani", Caracas, Bolivarian Republic of Venezuela
  2. 2Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
  3. 3Gynecologic Oncology, Clínica Universitaria Colombia and Centro de tratamiento e investigación sobre cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
  4. 4Hospital Infantil Universitario de San Jose. Fundación Universitaria de Ciencias de la Salud - FUCS, Bogotá, Colombia
  5. 5Vicerrectoría de Investigación, Fundación Universitaria de Ciencias de la Salud FUCS, Bogota, Colombia
  6. 6The University of Texas MD Anderson Cancer Center Department of Gynecologic Oncology and Reproductive Medicine, Houston, Texas, USA
  7. 7Gynecology and Obstetrics, Hospital General San Juan de Dios, Guatemala City, Guatemala
  8. 8Ginecología Oncológica, Hospital Sanatorio Allende, Cordoba, Argentina
  9. 9The University of Texas MD Anderson Cancer Center Research Medical Library, Houston, Texas, USA
  10. 10Gynecologic Oncology, ACCamargo Cancer Center, Sao Paulo, Brazil
  11. 11Gynecologic Oncology, Valencian Institute of Oncology (IVO), Valencia, Spain
  12. 12Universidad Nacional de Colombia Departamento de Obstetricia y Ginecología, Bogota, Colombia
  13. 13Grupo de Investigación Clínica y Epidemiológica del Cáncer, Instituto Nacional de Cancerología, Bogota, Colombia
  14. 14Gynecology, Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Medellin, Colombia
  1. Correspondence to Dr Rene Pareja, Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia; ajerapener{at}gmail.com

Abstract

Objective To assess the incidence of peritoneal carcinomatosis in patients undergoing minimally invasive or open radical hysterectomy for cervical cancer.

Methods The MEDLINE (accessed through Ovid), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials, and Scopus databases were searched for articles published from inception up to April 2022. Articles published in English were considered. The included studies reported on patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IA-IIA squamous cell carcinoma, adenocarcinoma, and/or adenosquamous carcinoma of the cervix who underwent primary surgery. Studies had to report at least one case of peritoneal carcinomatosis as a recurrence pattern, and only studies comparing recurrence after minimally invasive surgery versus open surgery were considered. Variables of interest were manually extracted into a standardized electronic database. This study was registered in PROSPERO (CRD42022325068).

Results The initial search identified 518 articles. After the removal of the duplicate entries from the initial search, two authors independently reviewed the titles and abstracts of the remaining 453 articles. Finally, 78 articles were selected for full-text evaluation; 22 articles (a total of 7626 patients) were included in the analysis—one randomized controlled trial and 21 observational retrospective studies. The most common histology was squamous cell carcinoma in 60.9%, and the tumor size was <4 cm in 92.8% of patients. Peritoneal carcinomatosis pattern represented 22.2% of recurrences in the minimally invasive surgery approach versus 8.8% in open surgery, accounting for 15.5% of all recurrences. The meta-analysis of observational studies revealed a statistically significant higher risk of peritoneal carcinomatosis after minimally invasive surgery (OR 1.90, 95% CI 1.32 to 2.74, p<0.05).

Conclusion Minimally invasive surgery is associated with a statistically significant higher risk of peritoneal carcinomatosis after radical hysterectomy for cervical cancer compared with open surgery.

  • cervical cancer
  • adenocarcinoma
  • peritoneum
  • laparoscopes
  • laparotomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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Footnotes

  • Twitter @oncohoegl, @AnaTatianaPala1, @mderickestrada, @FlorenciaNoll, @glaucobaiocchi, @RParejaGineOnco

  • Contributors JH: investigation, writing - original draft, writing - review, editing and responsible for the overall content as guarantor. DV-C: conceptualization, methodology, writing - review, and editing. TP: investigation, data curation. AG: conceptualization, methodology. ARH: investigation, methodology, editing. EE: investigation, data curation. FN: investigation, data curation. KK: conceptualization, methodology, search strategy. GB: investigation, methodology, editing. LM: investigation, methodology, editing. CG-A: conceptualization, methodology, formal analysis. RP: conceptualization, formal analysis, review and editing, supervision.

  • 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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