Laparascopic Surgeryy Versus Abdominal Surgery In Endometrial Cancer-Meta Analysis

OBJECTIVE:To evaluate the Safety and efficacy of laparoscopic hysterectomy and abdominal hysterectomy in the treatment of early endometrial cancer.Methods:an electronic search was conducted using National Library of Medicine’s MEDLINE database, EMBASE, Cochrane Collaboration’s CENTRAL database and wangfang data database, included studies consisted of randomized controlled trial (RCT) comparing the outcomes of laparoscopic hysterectomy and abdominal hysterectomy in treatment of early endometrial cancer.pooled estimated for risk ratio (RR)95% confidential intervals were obtained for primary and secondary outcomes using the Cochrane collaboration’s RevMan version 5.3RESULTS:the literature search ultimately yielded 12 RCT enrolling 4908 patients.there were 2952 patients randomly assigned to laparoscopic hysterectomy group and 1956 patients were randomly assigned to abdominal hysterectomy group.According to meta-analysis result, laparoscopic surgery was associated with relatively decreased intra operative bleeding [MD-103。73,95%CI (-133， 67～-73。80),(P=0.00001)], less post operative complications[RRO。64,95%CI, (0。61～0.81), (P=0.00001)], less hospital stay [MD-2。97,95%CI(-3.75～-2.20),(p=0.00001)], but operative time was relative longer in laparoscopic group [MD 29.32,95% CI (18.32-87.18),(p=00001)], no difference in intra operative complication [RR1。00,95%CI, (0。81～1.23, (P=0.99), less bowel bladder and ureter injury [RR 0.75,95%CI, (0.60～0.94), (P=0.01)] lymph node yeild[MD 0。69,95%CI (-0。 46～1.84), (P=0.24)]recurrence rate [RR 0. 92,95%CI (0。63～1。35),(P=0.68)], mortality rate [RR 0.83,95%CI (0.59～1.16), (p=0.28)], overall survival rate [RR 1.00,95%CI (0.96～1.04),(P=0.95)]Conclusion:compared with TAH, TLH can benefit patients with endometrial cancer with lower risk of total complications, major complication and post operative complications. Decreased intra operative bleeding and quick recovery of patients undergoing TLH has its own clinical importance, intra operative complications rate, recurrence, overall survival, mortality doesn’t increase in laparoscopic surgery Besides, more randomized controlled trial using longer term of outcome assessments and more patient outcomes are urgently needed to further identify the long term outcomes of laparoscopic approach for patients with endometrial cancer.