Meta-Analysis Of The Benefits And Security Of Radical Cervical Cancer Surgery Plus PAL In Early Stage Cervical Cancer

Objective:Using systematic review and meta-analysis to compare the clinical efficacy and safety of adding para-aortic lymphadenectomy(PAL)to radical hysterectomy(RH)and pelvic lymphadenectomy(PL)in the treatment of early cervical cancer.Methods:Retrieve all original literature from major databases(such as CNKI,Wanfang,CBM,VIP,Duxiu,PubMed,Web of Science,Embase,The Cochrane Library,etc.)since the establishment of the databases.Meanwhile,retrieve relevant and highly related reference literature included in the literature review.Screening and evaluation based on inclusion and exclusion criteria,and valid data were extracted from the finally included literature.The data were processed using Rev Man 5.3 and STATA 16.0 software,and the results of combined statistics were analyzed.Results:A collection of 18 literatures was included,containing nine randomised controlled trials(PAL),three non-randomised intervention trials and six retrospective cohort studies.A number of 1494 patients suffering from early stage cervical cancer were covered,including 688 cases in the RH+PL+PAL group and 806 cases in the RH+PL group.Due to the significant impact of different surgical approaches on outcome indicators,the included literature was divided into open and laparoscopic subgroups for statistical analysis.There were 15 literatures in the open subgroup and only 3 literatures in the laparoscopic subgroup with fewer common outcome indicators.Meta-analysis of the open subgroup showed that the addition of PAL reduced the 1st-year recurrence rate(RR=0.34,95% CI:0.22-0.52,P<0.00001)and the three-year and beyond recurrence rate(RR=0.41,95% CI:0.30-0.57,P<0.00001).The addition of PAL improved overall survival at three years and beyond(RR=1.25,95% CI:1.15-1.36,P<0.00001)and disease-free survival at three years and beyond(RR=1.45,95% CI:1.13-1.86,P<0.05).However,For 1st-year survival,the effect of adding PAL was not significant.The overall survival rate at 1st-year was 1.06 times higher in the group with PAL than in the group without PAL(RR=1.06,95% CI:1.01-1.12,P<0.05),And there was no difference between the two groups regarding disease-free survival at the first year(RR=1.17,95% CI:0.90-1.54,P>0.05).Furthermore,in terms of perioperative-related indicators,the addition of PAL increased intraoperative bleeding by17.73 ml(95% CI:5.15-30.32,P<0.05),operative time by 3.96 min(95% CI:1.91-6.73,P<0.05)and hospital stay by 1.21 d(95% CI:0.54-1.87,P<0.05).Finally,there was no difference(P>0.05)in the overall rates of complications and specific types(lymphatic cysts,urinary retention,intestinal obstruction,liquefaction or dehiscence of the abdominal incision,lower limb venous thrombosis,and urinary tract injury)with or without the addition of PAL.On the other hand,results after Meta-analysis of the laparoscopic subgroup showed no difference in the amount of intraoperative bleeding,operative time,overall incidence of complications and incidence of lymphatic cysts with or without the addition of PAL(P>0.05).Conclusions:1.The addition of PAL to radical cervical cancer surgery under open surgical approach can effectively reduce the recurrence rate and improve the survival rate at three years and beyond,but it does not have a significant impact on the first-year survival rate.2.The addition of PAL to radical cervical cancer surgery under open surgical approach increases intraoperative bleeding and prolongs operation and hospitalization time to a certain extent,but does not increase the complication rate.3.The addition of PAL to radical laparoscopic approach for cervical cancer did not increase intraoperative bleeding,operation time,overall incidence of complications and incidence of lymphatic cysts.4.RH+PL+PAL for early-stage cervical cancer under open surgical approach is safe and effective.