Wing Lam Tsuia, Guang‑Hong Dengb, Tsung‑Cheng Hsiehb,c, Pei‑Chen Lia, Dah‑Ching Dinga,c*
aDepartment of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan, bResearch Center for Big Data Teaching, Research and Statistic Consultation, Tzu Chi University, Hualien, Taiwan, cInstitute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: Cervical cancer remains a leading cause of death among women globally, with surgery being a key treatment for early‑stage disease. However, the survival outcomes (disease‑free survival [DFS] and overall survival [OS]) of patients with early‑stage cervical cancer treated using different surgical methods remain controversial. This systematic review and meta‑analysis aimed to evaluate the survival outcomes of laparoscopic radical hysterectomy (LRH) versus open radical hysterectomy (ORH) for treating early‑stage cervical cancer (tumor ≤2 cm). Materials and Methods: A comprehensive search of the PubMed, Web of Science, and Cochrane databases from 1960 to 2022 identified 12 retrospective cohort studies for inclusion. The primary outcome included DFS and OS. The pooled hazard ratio (HR) with 95% confidence intervals (CI) was calculated to compare DFS and OS. The I2 statistic was used to estimate the heterogeneity of the included studies. A funnel plot was used to examine publication bias. Review Manager version 5.4 software was used for the analysis. P < 0.05 was statistically significant. Results: The results showed no significant difference between LRH and ORH in a 5‑year OS (HR = 1.25; 95% CI, 0.82–1.86; P = 0.3) or 5‑year DFS (HR = 1.03; 95% CI, 0.67–1.57; P = 0.9), with minimal publication bias in DFS. Conclusion: LRH is a safe and effective alternative to ORH for early‑stage cervical cancer, with similar survival outcomes. The results may encourage further research into optimizing minimally invasive techniques, potentially influencing the clinical guidelines and promoting the broader adoption of LRH in treating cervical cancer.
Keywords: Cervical cancer, Laparoscopy, Meta‑analysis, Radical hysterectomy, Systematic review
