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SYSTEMATIC REVIEW article

Front. Oncol.
Sec. Gynecological Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1524991

Different surgical methods of hysterectomy for the management of endometrial cancer: A systematic review and network meta-analysis

Provisionally accepted
Yuquan Yuan Yuquan Yuan 1Qin Tan Qin Tan 2Yingfan Chen Yingfan Chen 3Keyang Zhu Keyang Zhu 4Bin Pan Bin Pan 3Bao Liu Bao Liu 1Chunyan Ren Chunyan Ren 1Ganghui Li Ganghui Li 1Cheng Chen Cheng Chen 3Chengzhi Zhao Chengzhi Zhao 1*
  • 1 Chongqing Health Center for Women and Children, Chongqing, China
  • 2 Children‘s Hospital of Chongqing Medical University, Chongqing, Chongqing Municipality, China
  • 3 Chongqing General Hospital, Chongqing, Chongqing, China
  • 4 North Sichuan Medical College, Nanchong, Sichuan Province, China

The final, formatted version of the article will be published soon.

    Background: Emerging surgical methods are utilized to treat endometrial cancer. The study aimed to assess the efficacy and safety of four common surgical methods of hysterectomy.We systematically searched the PubMed, Cochrane Library databases, Medline, EMBASE and Web of Science from their inception until April 30, 2024. We used hazard ratios (HR) for overall survival (OS) and disease-free (DFS), odds ratios (OR) for categorical outcomes, and mean differences (MD) for continuous outcomes with 95% confidence intervals. These were pooled in Bayesian network meta-analysis models. The surface under the cumulative ranking curve (SUCRA) was used to illuminate the probability that each method would be the best for each outcome. Results: Thirty studies comprising 13446 patients were included. Robotic hysterectomy (RH) retrieved fewer pelvic lymph nodes than open hysterectomy (OH). OH showed a significantly higher postoperative complication rate than laparoscopic hysterectomy (LH) and RH. LH had a higher intraoperative complication rate than OH. According to SUCRA values, OH ranked the highest in the number of retrieved pelvic lymph nodes (0.89), intraoperative complications (0.73), and operative time (0.97). LH ranked the highest in DFS (0.81) and overall survival (OS) (0.87). RH ranked the highest in the postoperative complications (0.95). Laparoscopic-assisted vaginal hysterectomy (LAVH) ranked the highest in number of retrieved para-aortic lymph nodes (0.72). Conclusions: There are no significant differences among the four surgical methods in DFS or OS. The use of uterine manipulators does not affect prognosis. OH is the best method for shortening operative time, dissecting the pelvic lymph nodes and controlling intraoperative complications. LH and LAVH have an advantage in para-aortic lymph node dissection. Besides, LH has the best advantage in DFS and OS. RH has advantages in controlling surgical complications.

    Keywords: endometrial cancer, Hysterectomy, Meta-analysis, Systematic review, Surgical complications, prognosis

    Received: 08 Nov 2024; Accepted: 16 Dec 2024.

    Copyright: © 2024 Yuan, Tan, Chen, Zhu, Pan, Liu, Ren, Li, Chen and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Chengzhi Zhao, Chongqing Health Center for Women and Children, Chongqing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.