| Objective:To evaluate the surgical treatment for stage I low-risk endometrial cancer with or without lymph node dissection,to compare the efficacy and safety of the two surgical methods,and to provide some specific guidance for clinical selection.Methods:Chinese and foreign language databases were searched,including Pubmed,Cochrane Library,Web of Science,China Knowledge Network(CNKI),Wanfang,Wipu,and China Biomedical Database.All relevant literature on the efficacy and safety of lymph node dissection for stage I endometrial cancer published in domestic and foreign databases from January 2010 to December 2022.The various types of literature were screened according to the inclusion and exclusion criteria.The selected literature was evaluated using the Newcastle-Ottawa quality rating scale(NOS),and relevant indicators were extracted and statistically analyzed using Stata 15.1 software.Results:A total of 9 papers were included,including 7 papers in Chinese and 2papers in English,with 675 cases in the LND group and 489 cases in the N-LND group.meta-analysis results showed that(1)comparison in terms of postoperative recurrence rate: the RR(95% CI)value was 0.87(0.38,2.01),p=0.743(>0.05),indicating that the difference was not statistically significant,indicating that there was no significant difference in the postoperative recurrence rate between the LND group surgery and the N-LND group.(2)Comparison in the overall survival rate at 5 years after surgery: the RR(95% CI)value was 1.01(0.97,1.05),p=0.368(>0.05),indicating that the difference was not statistically significant,indicating that there was no significant difference in the overall survival rate at 5 years after surgery between the LND group and the N-LND group.(3)Comparison in terms of postoperative SF-36 scores: the WMD95%(CI)value was-5.79(-10.87,-0.71),p=0.025(<0.05),indicating a statistically significant difference,suggesting that the LND group had significantly worse quality of life than the N-LND group.(4)In terms of total postoperative complication rate: the RR(95% CI)value was 3.23(2.22,4.71),p=0.000(<0.05),indicating that the difference was statistically significant,and the total postoperative complication rate was significantly higher in the LND group than in the N-LND group.(5)In terms of operative time between the LND group and the N-LND group: the WMD(95% CI)value was 49.00(30.78,67.23),p=0.000(<0.05),indicating a statistically significant difference,suggesting that the LND group had a significantly longer operative time than the N-LND group.(6)In terms of intraoperative bleeding: the WMD(95% CI)value was 65.46(48.73,82.20),p=0.000(<0.05),indicating a statistically significant difference,suggesting that the LND group had significantly more intraoperative bleeding than the NLND group.(7)Comparison in terms of length of stay: the WMD(95% CI)value was3.85(1.48,6.23),p=0.001(<0.05),indicating a statistically significant difference,suggesting that the LND group had a significantly longer length of stay than the N-LND group.(8)Comparison in terms of duration of postoperative indwelling urinary catheter:the WMD(95% CI)value was 1.41(1.07,1.76),p=0.000(<0.05),indicating a statistically significant difference,indicating that the duration of postoperative indwelling urinary catheter was significantly longer in the LND group than in the N-LND group.Conclusions:This study demonstrates that in patients with stage I low-risk endometrial cancer,lymph node dissection is not routinely recommended for the first surgery based on the included literature.Compared with the N-LND group,the LND group may increase the operative time,intraoperative bleeding,hospital stay,intraoperative indwelling urinary catheter time,total postoperative complication rate,and decrease the postoperative quality of life score,and there is no significant difference between the two in terms of overall survival rate at 5 years after surgery and the level of postoperative recurrence rate. |
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