TY - JOUR T1 - Disease-Free and Survival Outcomes for Total Laparoscopic Hysterectomy Compared With Total Abdominal Hysterectomy in Early-Stage Endometrial Carcinoma: A Meta-analysis JF - International Journal of Gynecologic Cancer JO - Int J Gynecol Cancer SP - 529 LP - 538 DO - 10.1097/IGC.0000000000001199 VL - 28 IS - 3 AU - Rebecca Asher AU - Andreas Obermair AU - Monika Janda AU - Val Gebski Y1 - 2018/03/01 UR - http://ijgc.bmj.com/content/28/3/529.abstract N2 - 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. ER -