Comparison of robotic surgery with laparoscopy and laparotomy for treatment of endometrial cancer: a meta-analysis

Longke Ran; Jing Jin; Yan Xu; Youquan Bu; Fangzhou Song

doi:10.1371/journal.pone.0108361

Comparison of robotic surgery with laparoscopy and laparotomy for treatment of endometrial cancer: a meta-analysis

PLoS One. 2014 Sep 26;9(9):e108361. doi: 10.1371/journal.pone.0108361. eCollection 2014.

Authors

Longke Ran¹, Jing Jin², Yan Xu³, Youquan Bu⁴, Fangzhou Song⁴

Affiliations

¹ Department of Bioinformatics, Chongqing Medical University, Chongqing, China; Molecular Medicine and Cancer Research Center, Chongqing Medical University, Chongqing, China.
² Department of Bioinformatics, Chongqing Medical University, Chongqing, China.
³ Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China.
⁴ Molecular Medicine and Cancer Research Center, Chongqing Medical University, Chongqing, China.

Abstract

Purpose: To compare the relative merits among robotic surgery, laparoscopy, and laparotomy for patients with endometrial cancer by conducting a meta-analysis.

Methods: The MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were searched. Studies clearly documenting a comparison between robotic surgery and laparoscopy or between robotic surgery and laparotomy for endometrial cancer were selected. The outcome measures included operating time (OT), number of complications, length of hospital stay (LOHS), estimated blood loss (EBL), number of transfusions, total lymph nodes harvested (TLNH), and number of conversions. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated using either a fixed-effects or random-effects model.

Results: Twenty-two studies were included in the meta-analysis. These studies involved a total of 4420 patients, 3403 of whom underwent both robotic surgery and laparoscopy and 1017 of whom underwent both robotic surgery and laparotomy. The EBL (p = 0.01) and number of conversions (p = 0.0008) were significantly lower and the number of complications (p<0.0001) was significantly higher in robotic surgery than in laparoscopy. The OT, LOHS, number of transfusions, and TLNH showed no significant differences between robotic surgery and laparoscopy. The number of complications (p<0.00001), LOHS (p<0.00001), EBL (p<0.00001), and number of transfusions (p = 0.03) were significantly lower and the OT (p<0.00001) was significantly longer in robotic surgery than in laparotomy. The TLNH showed no significant difference between robotic surgery and laparotomy.

Conclusions: Robotic surgery is generally safer and more reliable than laparoscopy and laparotomy for patients with endometrial cancer. Robotic surgery is associated with significantly lower EBL than both laparoscopy and laparotomy; fewer conversions but more complications than laparoscopy; and shorter LOHS, fewer complications, and fewer transfusions but a longer OT than laparoscopy. Further studies are required.

Publication types

Comparative Study
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Endometrial Neoplasms / surgery*
Female
Humans
Laparoscopy / methods*
Laparotomy / methods*
Robotics / methods*

Grants and funding

This work was supported by grants from the National Natural Science Foundation of China (Nos. 81101994 and 81072125). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.