Comparison of Minimally Invasive Versus Abdominal Radical Hysterectomy for Early-Stage Cervical Cancer: An Updated Meta-Analysis

Outcomes and patterns of recurrence of robot‑assisted or laparoscopic radical hysterectomy in early‑stage cervical cancer

The present study aimed to evaluate the surgical outcomes and prognosis of minimally invasive surgery (MIS), including robot-assisted radical hysterectomy (RARH) and laparoscopic radical hysterectomy (LRH), and open radical hysterectomy (ORH) for the treatment of early stage cervical cancer. A total of 43 patients were enrolled into the ORH group, 14 patients into the LRH group and 21 patients into the RARH group, and the patients were followed up for ≥3 years. Age, body mass index, International Federation of Gynecology and Obstetrics 2008 stage, histology, tumor size, lymphovascular space invasion, lymph node metastasis, number of dissected lymph nodes, operative duration, estimated blood loss, hospitalization duration and complications were reviewed. On follow-up, 16.3% of relapses (7/43) and 11.6% of deaths (5/43) occurred in the ORH group. In the LRH group, 14.3% of patients relapsed (2/14) and no deaths were reported; however, in the RARH group, 33.3% of patients relapsed and 9.5% died (2/21). In patients treated with RARH, >50% of recurrences occurred in distant lesions because of metastasis. No significant difference was found in patient prognosis between the three groups. The difference in 3-year recurrence between the MIS and ORH groups was not statistically significant (MIS vs. ORH, 74.3 vs. 83.7%; log-rank P=0.253). In addition, there was no recurrence in patients with stage IB1 cervical cancer in the RARH group. LRH and RARH were superior to ORH with regard to surgical outcomes, such as estimated blood loss, and therefore may be considered a safe and feasible alternative to ORH. However, RARH would not be an appropriate surgical approach in patients with large tumors and parametrial invasion. In the future, the ideal indications for each surgical procedure should be reassessed, and the significance of the relationship between the difficulty of surgery, such as in cases of bulky tumor, parametrium invasion and vaginal invasion, and disease recurrence should be discussed. In conclusion, MIS could be safe and useful if proper case selection is performed.

Cost-Utility Analysis of Open Radical Hysterectomy Compared to Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

We aimed to investigate the cost-effectiveness of open surgery, compared to minimally invasive radical hysterectomy for early-stage cervical cancer, using updated survival data. Costs and utilities of each surgical approach were compared using a Markovian decision analysis model. Survival data stratified by surgical approach and surgery costs were received from recently published data. Average costs were discounted at 3%. The value of health benefits for each strategy was calculated using quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio, calculated using the formula (average cost minimal invasive surgery-average cost open surgery)/(average QALY minimal invasive surgery-average QALY open surgery), was used for cost-effectiveness analysis. One-way sensitivity analysis was conducted for all variables. Open radical hysterectomy was found to be cost-saving compared to minimally invasive surgery with an incremental cost-effectiveness ratio of USD -66 and USD -373 for laparoscopic and robotic surgery, respectively. The most influential parameters in the model were surgery costs, followed by the disutility involved with open surgery. Until further data are generated regarding the survival of patients with early-stage cervical cancer treated by minimally invasive surgery, at current pricing, open radical hysterectomy is cost-saving compared to minimally invasive radical hysterectomy, both laparoscopic and robotic.

Laparoscopic Versus Abdominal Radical Hysterectomy for Cervical Cancer: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Laparoscopic radical hysterectomy (LRH) and open abdominal radical hysterectomy (ARH) have been used for cervical cancer treatment. We aimed to perform a meta-analysis to compare the efficacy and safety of LRH and ARH in the treatment of cervical cancer to provide reliable evidence to the clinical cervical cancer treatment.

METHODS

Two investigators independently searched PubMed and other databases for randomized controlled trials (RCTs) comparing LRH and ARH for cervical cancer treatment up to May 31, 2022. The risk of bias assessment tool recommended by Cochrane library was used for quality assessment. RevMan 5.3 software was used for meta-analysis.

RESULTS

Fourteen RCTs with a total of 1700 patients with cervical cancer were finally included. Meta-analyses indicated that compared with ARH, LRH reduced the intraoperative blood loss (mean difference [MD]=-58.08; 95% CI, -70.91, -45.24), the time to first passage of flatus (MD=-14.50; 95% CI, -16.55, -12.44) (all P <0.05), and increase the number of lymph nodes removed (MD=3.47; 95% CI, 0.51, 6.43; P =0.02). There were no significant differences in the duration of surgery (MD=27.62; 95% CI, -6.26, 61.49), intraoperative complications (odd ratio [OR]=1.10; 95% CI, 0.17, 7.32), postoperative complications (OR=0.78; 95% CI, 0.33, 1.86), relapse rate (OR=1.45; 95% CI, 0.56, 3.74), and survival rate (OR=0.75; 95% CI, 0.52, 1.08) between LRH group and ARH group (all P >0.05).

CONCLUSIONS

LRH has more advantages over ARH in the treatment of cervical cancer. Still, the long-term effects and safety of LRH and ARH need more high-quality, large-sample RCTs to be further verified.