Laparoscope Versus Laparotomy in Treatment of Early-stage Cervical Cancer: A Systematic Review

Objective To assess the efficacy and safety of laparoscopy in the surgical treatment of early-stage cervical cancer.

Methods Trials were searched by CENTRAL (2016, issue 3), MEDLINE, EMBASE, PUBMED, CBM, CNKI, Wan Fang and VIP. Unpublished and Grey literatures were hand-searched. The literature was screened according to the inclusive and exclusive criteria by two reviewers independently. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) about laparoscopic surgery versus laparotomy for early stage cervical cancer were selected. The methodology quality was evaluated after abstracting the data, then the RevMan 5.1 software was used for Meta-analyses.

Results The search yielded five CCTs and one RCT with 322 cervical cancer patients. There was no significant difference between laparoscopic and laparotomic approaches to early stage cervical cancer in 3-year overall survival, 3-year recurrence rate, intra-operative complications rates, post-operative complications rates or pelvic nodes yield (all P > 0.05). The benefits of laparoscopic surgery versus laparotomy were shorter length of hospital stay and less blood loss. The disadvantage was the longer time of surgical procedure.

Conclusion Laparoscopic surgery appears to show benefits for female patients with early stage cervical cancer as compared with laparotomy in the length of hospital stay and blood loss. However, further well-designed, multi-centre RCTs are needed to assess the long-term clinical outcomes, particularly the quality of life.