开腹手术和微创手术治疗子宫内膜癌的疗效及安全性的Meta分析

Meta-Analysis of the Efficacy and Safety of Open versus Minimally Invasive Surgery in the Treatment of Endometrial Cancer

摘要: 背景：在子宫内膜癌中，开腹手术或微创手术这两种方法都有各自的优点，但关于它们的安全性仍存在争议。需要一项Meta分析来全面评估这些手术方法的安全性，旨在为临床决策提供清晰的信息并改善患者预后。目的：本文旨在通过Meta分析比较子宫内膜癌开腹手术与微创手术在安全性方面的差异，以提供更全面的临床决策支持。方法：在电子数据库(PubMed、Embase和Web of Science)中进行系统性文献检索，文献检索结果涵盖2010年1月至2024年1月。根据纳入和排除标准，收集研究子宫内膜癌患者开腹与腹腔镜或机器人术后生存结局的文章。结果：最终共纳入12篇重点文献，涉及5450例患者。主要结局包括术后复发率、术后死亡率和术后并发症。次要结局包括局部复发、远处复发、手术操作时间和术中失血量。采用固定效应模型或随机效应模型计算合并比值比(OR)和95%置信区间(CI)。同时评估了文章的异质性和发表偏倚。结论：这项Meta分析为子宫内膜癌开腹手术与微创手术的安全性提供了有价值的见解。与开腹手术相比，微创手术在降低术后复发率、死亡率、并发症和失血量等方面具有优势，在手术操作时间上显著延长。然而，开腹手术和微创手术在术后局部复发和远处复发方面未显示出明显差异。因此，手术方式的选择还是应根据患者特征、肿瘤特征和妇科医生的专业知识进行综合研判和个体化分析，这需要临床工作者进一步的研究和长期随访研究来验证这些发现和选择。

Abstract: Background: In endometrial cancer, both approaches, open surgery and minimally invasive surgery have their own advantages, but controversy remains regarding their safety. A Meta-analysis is needed to comprehensively assess the safety of these surgical approaches with the aim of providing clarity for clinical decision-making and improving patient prognosis. Objective: The aim of this paper is to compare the differences in safety between open surgery and minimally invasive surgery for endometrial cancer through Meta-analysis to provide more comprehensive clinical decision support. Methods: A systematic literature search was performed in electronic databases (PubMed, Embase, and Web of Science) with literature search results covering the period from January 2010 to January 2024. Articles examining survival outcomes after open versus laparoscopic or robotic surgery in patients with endometrial cancer were collected according to inclusion and exclusion criteria. Results: A total of 12 focused papers involving 5450 patients were ultimately included. Primary outcomes included postoperative recurrence rate, postoperative mortality, and postoperative complications. Secondary outcomes included local recurrence, distant recurrence, surgical operation time and intraoperative blood loss. Combined odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using either a fixed-effects model or a random-effects model. Heterogeneity of articles and publication bias were also assessed. Conclusion: This Meta-analysis provides valuable insights into the safety of open versus minimally invasive surgery for endometrial cancer. Minimally invasive surgery offered advantages in reducing postoperative recurrence, mortality, complications, and blood loss compared with open surgery, and was significantly prolonged in terms of surgical operation time. However, open versus minimally invasive surgery did not show significant differences in postoperative local recurrence and distant recurrence. Therefore, the choice of surgical modality should still be based on a comprehensive study and individualized analysis based on patient characteristics, tumor characteristics and gynecologic surgeon’s expertise, which requires further research and long-term follow-up studies by clinical practitioners to validate these findings and choices.