Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis

Abstract

Objective To investigate morbidity for patients after the primary surgical management of cervical cancer in low and middle-income countries (LMIC). Methods The Pubmed, Cochrane, the Cochrane Central Register of Controlled Trials, Embase, LILACS and CINAHL were searched for published studies from 1 st Jan 2000 to 30 th June 2017 reporting outcomes of surgical management of cervical cancer in LMIC. Random-effects meta-analytical models were used to calculate pooled estimates of surgical complications including blood transfusions, ureteric, bladder, bowel, vascular and nerve injury, fistulae and thromboembolic events. Secondary outcomes included five-year progression free (PFS) and overall survival (OS). Findings Data were available for 46 studies, including 10,847 patients from 11 middle income countries. Pooled estimates were: blood transfusion 29% (95%CI 0.19–0.41, P = 0.00, I 2 = 97.81), nerve injury 1% (95%CI 0.00–0.03, I 2 77.80, P = 0.00), bowel injury, 0.5% (95%CI 0.01–0.01, I 2 = 0.00, P = 0.77), bladder injury 1% (95%CI 0.01–0.02, P = 0.10, I 2 = 32.2), ureteric injury 1% (95%CI 0.01–0.01, I 2 0.00, P = 0.64), vascular injury 2% (95% CI 0.01–0.03, I 2 60.22, P = 0.00), fistula 2% (95%CI 0.01–0.03, I 2 = 77.32, P = 0.00,), pulmonary embolism 0.4% (95%CI 0.00–0.01, I 2 26.69, P = 0.25), and infection 8% (95%CI 0.04–0.12, I 2 95.72, P = 0.00). 5-year PFS was 83% for laparotomy, 84% for laparoscopy and OS was 85% for laparotomy cases and 80% for laparoscopy. Conclusion This is the first systematic review and meta-analysis of surgical morbidity in cervical cancer in LMIC, which highlights the limitations of the current data and provides a benchmark for future health services research and policy implementation.

Survival after Laparoscopic versus Abdominal Radical Hysterectomy in Early Cervical Cancer: A Randomized Controlled Trial

“…In our study, LRH and ARH had equivalent survival rates, supporting some previous comparative studies (Díaz-Feijoo et al, 2008;Nam et al, 2012;Cao et al, 2015;Wang et al, 2016). A study compared IA2-IIB 95%: 0.75-0.89) (Allanson et al, 2019). However our mean differences IN OS of 16.3 months, 10.4%, and 2.05 fold, favoring ARH, and our mean differences in DFS of 14,75 months, 12.6%, and 2.13 fold, favoring ARH, could not be negligible.…”

“…A population-based study compared 475 LRH patients to 483 ARH patients operated on from 2006 to 2017 with a median follow-up of 6 years, adjusted for patient factors and surgeon volume, concluded that LRH was oncologically safe for IA but not IB tumors (Cusimano et al, 2019). A systematic review of 4731 patients in 17 studies that included only low-and middle-income countries described similar overall and DFS rates for LRH and ARH (Allanson et al, 2019).…”

Incidence, Treatment and Outcomes of Cervical Cancer in Low- and Middle-income Countries

“…Surgery is the mainstay of treatment in early stages. In a systematic review, it was observed that the perioperative acute complications were comparable amongst LMICs and high-income countries [20]. However, reporting of longterm outcomes is suboptimal due to various reasons, including inappropriate selection criteria, availability of adjuvant therapies in high-risk groups and also the common use of neoadjuvant chemotherapy (NACT) prior to surgery in locally advanced stages.…”

Usefulness of Vascular Clips in Surgery for Gynecologic Cancer

“…In recent years, minimally invasive surgery such as laparoscopic surgery and robotic surgery has become the main trend in research on surgery for endometrial cancer and cervical cancer 1 . But it is still di cult for developing countries or hospitals without top facilities, and therefore it is necessary to improve the level of surgical technique by laparotomy 2,3,4,5 . Furthermore, because of the denial of the laparoscopic approach compared to the laparotomy for cervical cancer in the LACC trial rea rmed the importance of radical hysterectomy with the laparotomy approach 6 .…”