Comparison of laparoscopy and laparotomy for endometrial cancer

ObjectiveTo compare the safety and efficacy of laparoscopy and laparotomy on clinical outcomes among patients with endometrial cancer.MethodsEligible randomized controlled trials (RCTs) conducted between 1966 and June 2010 were analyzed by meta-analysis.ResultsEight RCTs were included, with 3599 patients in total. No significant difference was observed between laparoscopy and laparotomy in overall (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.50–1.82; P = 0.892), disease-free (OR, 0.96; 95% CI, 0.50–1.82; P = 0.892), or cancer-related (OR, 0.90; 95% CI, 0.27–3.08; P = 0.871) survival. More intraoperative complications (OR, 1.33; 95% CI, 1.03–1.73; P = 0.030), fewer postoperative complications (OR, 0.59; 95% CI, 0.46–0.75; P < 0.001), longer operative time (standardized mean difference [SMD], 0.80; 95% CI, 0.46–1.15; P < 0.001), lower blood loss (SMD, –2.29; 95% CI, –3.67 to − 0.91; P = 0.001), and shorter hospital stay (SMD, –2.60; 95% CI, –3.47 to − 1.72; P < 0.001) were associated with laparoscopy. There was no significant difference between the groups in pelvic (SMD, 0.22; 95% CI, –0.03 to 0.48; P = 0.086) or para-aortic (SMD, 0.54; 95% CI, –0.04 to 1.11; P = 0.067) lymph node yield.ConclusionLaparoscopy has short-term advantages and seemingly equivalent long-term outcomes and, in experienced hands, might be a feasible alternative to laparotomy for endometrial cancer.