| Objective :1.Evidence-based medicine has proved that single-port laparoscopic staging surgery for endometrial cancer is safe and feasible.2.Through the contrast analysis of the survival of patients with endometrial cancer who underwent three different surgical procedures to determine whether surgical methods were risk factors affecting the prognosis of endometrial cancer.3.Expound the safety,feasibility and effectiveness of rapid habilitation and tansumbilical single-port laparoscopy in staging operation of Endometrial Cancer.4.The immunohistochemical method was used to evaluate the response of UCHL1,CC chemokine ligand 2 CCI＿2,matrix metallopro-teinase,MMP1 and COL1A1 in different types of endometrial cancer surgery,to exploration of CO2 pneumoperitoneum on endometrial carcinoma metastasis related genes.5.By comparing the clinical indexes of the application of home-made PORT and finished PORT in transumbilical single-port laparoscopy,it is shown that home-made PORT can replace finished PORT in clinical application.Methods:1.Retrieved articles in the database published from the establishment of the database to January 19,2020,on the randomized controlled trial and observational study of single-port laparoscopic and porous laparoscopic staging operation for Endometrial Cancer,screened the kinds of literature according to the inclusion criteria and extracted relevant clinical indicators for meta-analysis.2.Survival analysis was conducted among the three groups of patients undergoing Single-Port Laparoscopic,multiport Laparoscopic and open surgery to determine whether the surgical approach was a risk factor affecting the prognosis of Endometrial Cancer.3.Using statistical methods,single-port laparoscopic group and the traditional multiport laparoscopic group were compared in the operation time,intraoperative estimated blood loss,intraoperative infusion volume,postoperative reduction of serum hemoglobin,postoperative hospitalization days,gastrointestinal recovery,intraoperative and postoperative complications,postoperative wound pain score and the wound score to check if there is a difference.4.Immunohistochemistry was used to evaluate the response of UCHL1,CC chemokine ligand 2.CCL2,matrix metalloproteinase,MMP1 and COL1A1 in different endometrial cancer operations5.Using statistical methods,compare homemade PORT and finished products in operation related indicators,such as operation time,blood loss,Number of lymph nodes dissected,postoperative pain and wound beauty,etc.Results:1.In a meta-analysis of the included literature,patients in the single-port laparoscopic group had a lower BMI than those in the multiport laparoscopic group(p<0.001),and the age of the two groups were equally comparable.The amount of surgical bleeding in the single-port laparoscopic group was less than that in the multiport laparoscopic group(p<0.001).There were no significant statistical differences in blood transfusion rate,pain score and incidence of intraoperative and postoperative complications.In the feasibility indicators,the hospitalization cost of the single-port laparoscopic group was less than that of the multiport laparoscopic group(p=0.001),the hospitalization time was shorter than that of the multiport laparoscopic group(p=0.001),and the postoperative exhaust time was earlier than that of the multiport laparoscopic group(p=0.001).The number of pelvic lymph node resection in the single-port laparoscopic group was less than that in the multiport laparoscopic group(p=0.037).The remaining operation time and the number of para-aortic lymph nodes were not abnormal.2.The results showed that the mortality of the three groups of patients was3.23% in the single-hole laparoscopic group,3.23% in the multiport laparoscopic group,and 11.29% in the open-surgery group.There was no statistically significant difference between the three groups(P=0.165).The recurrence rate was 6.46% in the single-port laparoscopic group,3.23% in the multiport laparoscopic group,and 6.46% in the open surgery group.The 1-year overall survival rate was 96.8%,98.4% and 91.5%,respectively,for patients undergoing single-port laparoscopic,multiport laparoscopic and open surgery.The 1-year progression-free survival rates of patients undergoing single-port laparoscopic,multiport laparoscopic and open surgery were 93.5%,94.7% and 91.7%,respectively.There was no statistically significant difference among the three groups.There was no statistically significant difference between OS and DFS in the three groups.Cox regression analysis of OS and DFS by single factor and multi-factor regression showed that P was greater than 0.05.Age,menopause or not,and tumour grade were stratified for the factors that may affect the prognosis of endometrial cancer,and all P>0.05.3.Single-port laparoscopic group and traditional multiport laparoscopic group in age,tumour differentiation degree,Figo staging,number of pelvic lymph nodes dissected and the number of para-aortic lymph nodes,the incidence of intraoperative and postoperative complications,the decrease of serum hemoglobin before and after surgery,the body character,general health,social function,emotional role,mental health has no statistical difference(P>0.05).However,there were statistical differences in operation time,intraoperative estimated blood loss,postoperative hospitalization days,Visual analog pain score,abdominal wound beauty score,body function,physical pain,vitality,rapid recovery and other aspects(P<05).4.UCHL1,CCL2 and MMP1 were positively expressed in endometrial cancer,while COL1A1 was negatively expressed.There was no difference in UCHL1,CCL2 and MMP1 in the single-port laparoscopic group,the multiport laparoscopic group and the open surgery group,P>0.05.Univariate and multivariate analyses showed that UCHL1,CCL2 and MMP1 were not risk factors for endometrial cancer prognosis(P>0.05).5.There was no statistically significant difference between the homemade PORT group and the finished PORT group in operation time,intraoperative blood loss,number of pelvic lymph node dissection,number of para-aortic lymph node dissection,postoperative exhaust time,complications,postoperative pain,wound beauty and Hospitalization days(P>0.05).Conclusion:1.Single-port laparoscopic surgery for the staging operation of endometrial cancer is safe and feasible.2.There was no difference in the mortality,recurrence rate,or 1-year overall survival rate and disease-free survival of endometrial cancer in the single-port laparoscopic group,the multiport laparoscopic group,or the open surgical group.3.The operation method is not an independent risk factor for endometrial cancer prognosis,but longer follow-up is needed to reconfirm.4.It has been preliminarily confirmed that compared with multiport laparoscopy and open surgery,single-port laparoscopy does not affect the prognosis of endometrial cancer,and the application of single-port laparoscopy in staging operation of endometrial cancer is safe and effective5.The application of ERAS technique in laparoscopic surgery for endometrial cancer has obvious advantages in the perioperative period,which is worthy of clinical promotion6.UCHL1,MMP1 and CCL2 were found to be positive in endometrial cancer.CO2 pneumoperitoneum did not affect the expression of UCHL1,MMP1 and CCL2 in endometrial cancer,and it was not clear that CO2 pneumoperitoneum affected the prognosis of endometrial cancer.7.Our study showed that the reactions of UCHL1,MMP1 and CCL2 had nothing to do with the prognosis of endometrial cancer,which was inconsistent with the literature reports,and there was a certain bias,which was considered to be related to the small sample size and short observation time of the study8.Homemade PORT can be used to replace the finished PORT in the staging operation of endometrial cancer with single-port laparoscopy.9.Meta-analysis further confirms the safety,feasibility and effectiveness of single-port laparoscopy in the staging of endometrial cancer surgery. |
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