Outcomes Associated with Different Surgical Approaches to Radical Hysterectomy: A Systematic Review and Network Meta-Analysis

Abstract

Background: Cervical cancer is among the most common gynecological cancers, and the fourth leading cause of death among women worldwide. Radical hysterectomy with pelvic lymph node dissection has been the mainstay of early stage cervical cancer treatment for decades; however, the procedure remains controversial. This systematic review and network meta-analysis aimed to evaluate the efficacy and safety of five different approaches to cervical cancer surgery. \n \nMethods: We searched PubMed, MEDLINE, Embase, the Cochrane Library, and Web of Science database, for high-quality, non-randomized comparative studies. Subsequently, we extracted the relevant data and conducted a network meta-analysis to compare clinical and perioperative outcomes, specifically, operation time (OT), intraoperative estimated blood loss (EBL) volume, length of hospital stay (LOS), number of resected lymph nodes (RLNs), rate of complications, and the rate of recurrence, and overall (OS) and progression-free (PFS) survival among patients that underwent robotic (RRH), open (ORH), laparoscopic (LRH), vaginal (LVRH), and vaginal assisted laparoscopic (VALRH) radical hysterectomy. \n \nResults: A total of 30 studies involving 11,353 cervical cancer patients were included in the present network meta-analysis. OS, PFS, and tumor recurrence rates did not differ among five surgical approaches. The SUCRA value showed that the VALRH was associated with the highest OS and lowest tumor recurrence rates, while LRH was associated with the highest PFS rate. In addition, RRH was associated with the lowest EBL volume and LOS, ORH was associated with the shortest OT. Finally, VALRH was associated with the greatest number of RLNs and lowest rate of perioperative complications. \n \nConclusion: The presented approaches to cervical cancer surgery have a comparable efficacy and safety profile. \n \nFunding Statement: This study was funded by the National Natural Science Foundation of China (Grant No.2018YFC1003100), and Beijing Municipal Science & Technology Commission (Grant No. Z131100006813023). \n \nDeclaration of Interests: The authors declare no conflicts of interest.