Comparison of survival outcomes between robotic and laparoscopic radical hysterectomies for early-stage cervical cancer: a systemic review and meta-analysis

Abstract

Objective Survival outcomes of robotic radical hysterectomy (RRH) remain controversial. Therefore, we performed a meta-analysis to evaluate survival outcomes between RRH) and laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer. Methods Studies comparing between RRH and LRH published up to November 2022 were systemically searched in the PubMed, Cochrane Library, Web of Science, ScienceDirect, and Google Scholar databases. Manual searches of related articles and relevant bibliographies of the published studies were also performed. Two researchers independently extracted data. Studies with information on recurrence and death after minimally invasive radical hysterectomy were also included. The extracted data were analyzed using the Stata MP software package version 17.0. Results Twenty eligible clinical trials were included in the meta-analysis. When all studies were pooled, the odds ratios of RRH for recurrence and death were 1.19 (95% confidence interval [CI]=0.91–1.55; p=0.613; I 2 =0.0%) and 0.96 (95% CI=0.65–1.42; p=0.558; I 2 =0.0%), respectively. In a subgroup analysis, the quality of study methodology, study size, country where the study was conducted, and publication year were not associated with survival outcomes between RRH and LRH. Conclusion This meta-analysis demonstrates that the survival outcomes are comparable between RRH and LRH. Trial Registration International Prospective Register of Systematic Reviews Identifier: CRD42023387916

Comparison of surgical and oncological outcomes between different surgical approaches for overweight or obese cervical cancer patients

“…LACC [ 2 ] and SUCCOR [ 31 ] trials mutually validate superior oncological survival outcomes of ORH over minimally invasive surgery in early-stage cervical cancer. Laparoscopic and robotic techniques have not been prospectively studied and have only been used as an emerging technique in radical hysterectomy in cervical cancer, possibly ignoring the principle of tumor-free operation, e.g., destruction of tumor tissue during the use of transcervical uterine manipulators and tumor dissemination caused by CO 2 pneumoperitoneum has been ignored [ 32 ]. Only overweight or obese patients with stage IBI–IIA2 cervical cancer were included in this study, and the results showed that the 5-year OS and RFS in RRH and LRH were comparable to ORH.…”

Robotic-assisted laparoscopic radical hysterectomy for early-stage cervical cancer: The more experienced the bedside assistant, the better?

“…Lowe reported that robotic-assisted laparoscopic radical hysterectomy associated with minimal blood loss and few operative complications offers an alternative to traditional radical hysterectomy [ 9 ]. A meta-analysis similarly showed that the survival outcomes are comparable between robotic and laparoscopic radical hysterectomy [ 10 ]. Furthermore, a multicenter randomized controlled trial reported that robotic-assisted laparoscopic radical hysterectomy (RACC trial) was non-inferior to laparotomy in terms of disease-free survival and had fewer postoperative complications [ 11 ].…”