Outcomes associated with different surgical approaches to radical hysterectomy: A systematic review and network meta-analysis

Abstract

Objective: To evaluate the efficacy and safety of five different approaches to cervical cancer surgery.

Methods: We conducted a systematic search for comparative studies on different radical hysterectomy types for cervical cancer in PubMed, Embase, the Cochrane Library, and Web of Science databases. All included observational studies used survival analyses to compare clinical outcomes of patients undergoing different radical hysterectomy types. All studies were assessed by the Newcastle-Ottawa Scale with scores of at least seven points. We extracted the relevant data and conducted a network meta-analysis to compare clinical outcomes among five surgical approaches.

Results: Thirty studies (n = 11 353) were included. Robotic surgery had the lowest blood loss volume and hospitalization duration; open surgery had the shortest operative time. Vaginal assisted laparoscopic surgery was associated with the highest number of resected lymph nodes and lowest rate of perioperative complications. Survival outcomes and tumor recurrence outcomes were similar among the approaches.

Conclusion: The current approaches to cervical cancer surgery have comparable efficacies.

Keywords: radical hysterectomy; surgical approaches; systematic review; vaginal surgery.