Comparison Of Clinical Safety And Efficacy Between Laparoscopy And Laparotomy In The Surgical Staging Of Endometrial Carcinoma:a Meta-Analysis

Objective To compare the clinical safety and efficacy between staging laparoscopy and laparotomy in endometrial carcinoma.Methods A search was conducted to collected the retrieve randomized controlled trials (RCTs) in the databases such as Cochrane Library, PubMed, EMbase, Ovid, CBM, CNKI, Chongqing VIP, Wanfang from January 1990 to December 2014. Manual retrieval of obstetrics and gynecology professional journals for articles about comparing the safety and efficacy between staging laparoscopy and laparotomy in endometrial carcinoma. The RevMan 5.3 software were used to analyze the data.Results Five relevant studies were identified(n=335 in laparoscopic group and n=298 in laparotomy group). The quality of literature was assessed using the Jadad scoring system, the scores of all studies were above 3 points. The laparoscopic has less of intra-operative bleeding loss (MD=-178.86,95%CI:-335.95～-21.77, P＝0.03) and hospitalization time (MD=-3.21,95%CI:-3.58～-2.85, P<0.00001). There was no significant difference between laparoscopy and laparotomy in the surgical staging of endometrial carcinoma in operation time (MD=20.48,95%CI:-8.31-49.28, P=0.16), the number of pelvic node yield (MD=-0.13,95%CI:-2.56～2.29, P=0.91) and para-aortic node yield (MD=0.58,95%CI:-2.05～3.22, P=0.66), rates of intra-operative complications ((OR=0.80,95%CI:0.26～2.51, P=0.70), postoperative complications (OR=0.88,95%CI:0.51-1.49, P=0.63) and overall complications (OR=0.57,95%CI:0.25～1.32, P=0.19).Descriptive statistics analysis showed that the difference of the recurrence rate (P> 0.05) and disease-free survival rate(P> 0.05)between staging laparoscopy and laparotomy was not statistically significant in endometrial carcinoma.Conclusion Compared with laparotomy, the laparoscopy seem to be beneficial in the surgical staging of endometrial cancer, in particular in hospitalization time and intraoperative bleeding loss. And the number of pelvic and para-aortic node yield was similar. The operation time, recurrence rate, disease-free survival, intra- and post-operative complication rates were at a same level.