Laparoscopy versus laparotomy for endometrial cancer：system review.

doi:10.7504/fk2014070110

Abstract

Abstract:

Abstract： Objective To evaluate the clinical efficacy and safety of laparoscopy versus laparotomy for treatment of endometrial cancer．Methods The databases such as Cochrane Library,PubMed,EMbase,Ovid,CBM，WanFang Data，VIP Information and CNKI were searched to collect the randomized control trials (RCTs) between January 1990 and September 2013. The software of meta-analysis was RevMan 5.1. Results A total 13 RCTs include 7640 patients．There was no significant difference between laparoscopic and laparotomic approaches to endometrial cancer in 3-5 years overall survival, recurrence at 3-5 years follow-up, and the number of pelvic node yield. The bene?ts of laparoscopic surgery versus laparotomy were lesser amount of intraoperative bleeding (P= 0.0001), shorter length of hospital stay (P<0.00001), lower rates of total complications (P<0.00001) and postoperative complications (P<0.00001). Disadvantages were higher rates of intraoperative complications (P=0.03) and longer duration of surgical procedures (P= 0.004). Conclusion Compared with laparotomy, laparoscopic surgery seems to be beneficial in women with endometrial cancer, in particular as total complications and length of hospital stay.

Key words: endometrial cancer, laparoscopic hysterectomy, laparotomy, systematic review, randomized controlled trial

摘要：

目的系统评价腹腔镜与开腹手术在子宫内膜癌治疗中的疗效及安全性。方法检索Cochrane Library、PubMed、EMbase、Ovid、CBM、万方、维普及CNKI等数据库1990年1月至2013年9月比较腹腔镜和开腹手术治疗所有期别的子宫内膜癌的随机对照试验，采用RevMan 5.1软件进行Meta分析。结果最终纳入13个随机对照试验，共7317例患者。Meta分析结果：两组术后随访3～5年子宫内膜癌患者总生存率、复发率以及清扫盆腔淋巴结数目无明显差别。与开腹手术相比，腹腔镜手术治疗子宫内膜癌术中出血量更少（P=0.0001），住院时间更短（P<0.00001），总并发症（P<0.00001）、术后并发症（P<0.00001）发生率更低。但腹腔镜组的术中并发症发生率高于开腹组（P=0.03）、手术时间较开腹组长（P=0.004）。结论与开腹手术相比，腹腔镜在子宫内膜癌的治疗中更有优势，尤其在总并发症和住院时间等方面优势更明显。

关键词: 子宫内膜癌, 腹腔镜手术, 开腹手术, 系统评价, 随机对照试验

CLC Number:

R711.74

XIAO Chang-ji, ZHAO Jing, GUO Peng, XIANG Yang.. Laparoscopy versus laparotomy for endometrial cancer：system review.[J]. Acta Metallurgica Sinica, DOI: 10.7504/fk2014070110.

肖长纪,赵静,郭朋,向阳. 腹腔镜手术治疗子宫内膜癌的系统评价[J]. 中国实用妇科与产科杂志, DOI: 10.7504/fk2014070110.

References

［1］    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013［J］. CA Cancer J Clin, 2013, 63: 11-30.

［2］    Salani R, Backes FJ, Fung MF, et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations［J］. Am J Obstet Gynecol, 2011, 204: 466-478.

［3］    Manchana T. Long-term lower urinary tract dysfunction in gynecologic cancer survivors［J］. Asian Pac J Cancer Prev, 2011, 12: 285-8.

［4］    冷金花, 史精华. 腹腔镜技术在妇科应用的热点问题［J］. 国际妇产科学杂志, 2012, 39: 436-439.

［5］    Garry R, Fountain J, Mason S, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy［J］. BMJ, 2004, 328: 129.

［6］   Carter JR. Laparoscopy or laparotomy for endometrial cancer? A review of three prospective randomised trials［J］. Aust N Z J Obstet Gynaecol, 2011, 51: 387-392.

［7］    Mueller F, Czaja N, Ulrich U. The laparoscopic-assisted vaginal approach to early endometrial cancer［J］. Arch Gynecol Obstet, 2010, 282: 177-183.

［8］    Maenpaa JU, Nyberg R, Parkkinen J. Port-site metastasis following laparoscopic hysterectomy and bilateral salpingo-ophorectomy for endometrial carcinoma［J］. Eur J Obstet Gynecol Reprod Biol, 2009, 143: 61-62.

［9］    Fram KM. Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer［J］. Int J Gynecol Cancer, 2002, 12: 57-61.

［10］   Zorlu CG, Simsek T, Ari ES. Laparoscopy or laparotomy for the management of endometrial cancer［J］. JSLS, 2005, 9: 442-446.

［11］   Tozzi R, Malur S, Koehler C, et al. Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study［J］. J Minim Invasive Gynecol, 2005, 12: 130-136.

［12］    Malzoni M, Tinelli R, Cosentino F, et al. Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study［J］. Gynecol Oncol, 2009, 112: 126-133.

［13］    Zullo F, Palomba S, Falbo A, et al. Laparoscopic surgery vs laparotomy for early stage endometrial cancer: long-term data of a randomized controlled trial［J］. Am J Obstet Gynecol, 2009, 200: 296 e1-9.

［14］   Walker JL, Piedmonte MR, Spirtos NM, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2［J］. J Clin Oncol, 2009, 27: 5331-5336.

［15］   Mourits MJ, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial［J］. Lancet Oncol, 2010, 11: 763-771.

［16］   Janda M, Gebski V, Brand A, et al. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial［J］. Lancet Oncol, 2010, 11: 772-780.

［17］   Kluivers KB, Ten Cate FA, Bongers MY, et al. Total laparoscopic hysterectomy versus total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial carcinoma: a randomised controlled trial with 5-year follow-up［J］. Gynecol Surg, 2011, 8: 427-434.

［18］   Obermair A, Janda M, Baker J, et al. Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer: results from a randomised controlled trial［J］. Eur J Cancer, 2012, 48: 1147-1153.

［19］   Walker JL, Piedmonte MR, Spirtos NM, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study［J］. J Clin Oncol, 2012, 30: 695-700.

［20］   Lu Q, Liu H, Liu C, et al. Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a prospective randomized study with 11-year experience［J］. J Cancer Res Clin Oncol, 2013, 139(11):1853-1859.

［21］    陈晓红, 黄浩. 腹腔镜与开腹手术治疗子宫内膜癌的临床对比分析—前瞻性随机对照研究［J］. 中国微创外科杂志, 2007, 7: 210-212.

［22］   Childers JM, Surwit EA. Combined laparoscopic and vaginal surgery for the management of two cases of stage I endometrial cancer［J］. Gynecol Oncol, 1992, 45: 46-51.

［23］   Devaja O, Samara I, Papadopoulos AJ. Laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) in endometrial carcinoma: prospective cohort study［J］. Int J Gynecol Cancer, 2010, 20: 570-575.

［24］   Hilaris GE, Tsoubis T, Konstantopoulos V, et al. Feasibility, safety, and cost outcomes of laparoscopic management of early endometrial and cervical malignancy［J］. JSLS, 2009, 13: 489-495.

［25］   Bijen CB, Vermeulen KM, Mourits MJ, et al. Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: a randomised trial［J］. Gynecol Oncol, 2011, 121: 76-82.

［26］   Bijen CB, de Bock GH, Vermeulen KM, et al. Laparoscopic hysterectomy is preferred over laparotomy in early endometrial cancer patients, however not cost effective in the very obese［J］. Eur J Cancer, 2011, 47: 2158-2165.

                                               （2014-02-20收稿   2014-05-07修回）

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