Comparison of the complications between minimally invasive surgery and open surgical treatments for early-stage cervical cancer: A systematic review and meta-analysis.
Comparison of the complications between minimally invasive surgery and open surgical treatments for early-stage cervical cancer: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0253143
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Wang Y
中科院分区：
文献类型：
--
作者：
Li Y;Kong Q;Wei H;Wang Y
这项荟萃分析综合比较了宫颈癌微创手术和开腹手术的术中和术后并发症。尽管在妇科疾病的治疗中，开腹手术在无病生存期和总生存期方面的优势已经被引用，但缺乏实质性的证据来证明一种手术方式相对于另一种手术方式的优势，而且在安全性和有效性方面，还不能确定是否有合理的理由采用开腹手术。在这项荟萃分析中，研究摘要比较早期(国际妇产科联合会分类IA1-IIB期)子宫颈癌患者行开腹根治性子宫切除术与开腹根治性子宫切除术的并发症结局。主要结果是术中总的并发症以及术后的总并发症。次要结果包括个别并发症。两名调查人员独立进行了筛选和数据提取。所有符合资格标准的文章都纳入了这项荟萃分析。Meta分析最终纳入39篇非随机研究和1篇随机对照试验(8篇关于机器人根治性子宫切除术(RRH)与开腹根治性子宫切除术(ORH)的研究，27篇关于腹腔镜下根治性子宫切除术(LRH)与ORH的研究，以及5篇关于这三种手术方式的研究)。合并分析显示，与ORH组相比，MI组的术中总并发症风险较高(OR=1.41，95%CI=1.07~1.86，P<；0.05)。但与手术切除组相比，微创手术组术后并发症发生率显著降低(OR=0.40，95%CI=0.34~0.48，P=0.0143)。在个别并发症方面，在减少输血、伤口感染、盆腔感染和脓肿、淋巴水肿、肠梗阻、肺栓塞、深静脉血栓形成、尿路感染等并发症方面有积极作用。此外，在增加膀胱切开、肠损伤、皮下气肿和瘘管等并发症方面，管理信息系统也有负面影响。我们的荟萃分析结果表明，与开腹手术相比，微创手术优于开腹手术，术后总的并发症(伤口感染、盆腔感染和脓肿、淋巴水肿、肠梗阻、肺栓塞和尿路感染)较少。然而，MIS术中聚集并发症(膀胱切开、肠损伤和皮下气肿)和术后瘘管并发症的风险较高。
This meta-analysis comprehensively compared intraoperative and postoperative complications between minimally invasive surgery (MIS) and laparotomy in the management of cervical cancer. Even though the advantages of laparotomy over MIS in disease-free survival and overall survival for management of gynecological diseases have been cited in the literature, there is a lack of substantial evidence of the advantage of one surgical modality over another, and it is uncertain whether MIS is justifiable in terms of safety and efficacy. In this meta-analysis, the studies were abstracted that the outcomes of complications to compare MIS (laparoscopic or robot-assisted) and open radical hysterectomy in patients with early-stage (International Federation of Gynecology and Obstetrics classification stage IA1-IIB) cervical cancer. The primary outcomes were intraoperative overall complications, as well as postoperative aggregate complications. Secondary outcomes included the individual complications. Two investigators independently performed the screening and data extraction. All articles that met the eligibility criteria were included in this meta-analysis. The meta-analysis finally included 39 non-randomized studies and 1 randomized controlled trial (8 studies were conducted on robotic radical hysterectomy (RRH) vs open radical hysterectomy (ORH), 27 studies were conducted on laparoscopic radical hysterectomy (LRH) vs ORH, and 5 studies were conducted on all three approaches). Pooled analyses showed that MIS was associated with higher risk of intraoperative overall complications (OR = 1.41, 95% CI = 1.07–1.86, P<0.05) in comparison with ORH. However, compared to ORH, MIS was associated with significantly lower risk of postoperative aggregate complications (OR = 0.40, 95% CI = 0.34–0.48, P = 0.0143). In terms of individual complications, MIS appeared to have a positive effect in decreasing the complications of transfusion, wound infection, pelvic infection and abscess, lymphedema, intestinal obstruction, pulmonary embolism, deep vein thrombosis, and urinary tract infection. Furthermore, MIS had a negative effect in increasing the complications of cystotomy, bowel injury, subcutaneous emphysema, and fistula. Our meta-analysis demonstrates that MIS is superior to laparotomy, with fewer postoperative overall complications (wound infection, pelvic infection and abscess, lymphedema, intestinal obstruction, pulmonary embolism, and urinary tract infection). However, MIS is associated with a higher risk of intraoperative aggregate complications (cystotomy, bowel injury, and subcutaneous emphysema) and postoperative fistula complications.
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影响因子：
3.9
作者：
Bogani, Giorgio;Rossetti, Diego;Raspagliesi, Francesco
通讯作者：
Raspagliesi, Francesco
影响因子：
4.7
作者：
Brandt, Benny;Sioulas, Vasileios;Leitao, Mario M., Jr.
通讯作者：
Leitao, Mario M., Jr.
影响因子：
4.1
作者：
Diver, Elisabeth;Hinchcliff, Emily;Growdon, Whitfield
通讯作者：
Growdon, Whitfield
DOI：
10.1016/s0197-2456(99)00026-4
发表时间：
1999-10-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
Clark, HD;Wells, GA;Laupacis, A
通讯作者：
Laupacis, A
DOI：
10.1111/igc.0b013e3181b76640
发表时间：
2009-11-01
影响因子：
4.8
作者：
Chong, Gun Oh;Park, Nae Yoon;Lee, Yoon Soon
通讯作者：
Lee, Yoon Soon