Systematic review and meta-analysis of robotic radical hysterectomy vs. open radical hysterectomy for early stage cervical cancer

Abstract

Objective

Recent data has brought into question the safety of minimally invasive techniques for radical hysterectomy in the treatment of early stage cervical cancer. After the publication of several new studies, we aimed to compare robotic radical hysterectomy (RRH) with open radical hysterectomy (ORH) in the management of women with early stage cervical cancer, while excluding minimally invasive cases performed without robotic assistance.

Data Sources

We searched six databases from inception until 11/30/2021. The original search found 233 unique papers, and ultimately 35 studies, comprising 11,888 total radical hysterectomies, met criteria for our final analysis. We included all studies including the intervention of RRH for early stage cervical cancer, with the comparator of ORH. We included randomized clinical trials (RCTs), case-control, retrospective cohort, and prospective cohort. We included studies that had robotic and laparoscopic arms, but excluded any studies that did not specifically provide specific data as to each group. We analyzed continuous data using mean difference and a 95% confidence interval, while dichotomous data were analyzed using odds ratio and a 95% confidence interval.

Results

We found that there was no significant difference between RRH and ORH regarding five-year Overall Survival (OR=1.28[0.66,2.46], (P = 0.46)), disease free survival (OR=0.94[0.77,1.14], (P = 0.51)), or recurrence (OR=0.92[0.75,1.13], (P = 0.44)) intraoperative complications (OR=0.75[0.55,1.02], (P = 0.07)), or mortality (OR=0.81[0.53,1.22], (P = 0.31)).

We found that RRH was better than ORH in terms of estimated blood loss (MD=-397.95[-471.65,-324.24], (P < 0.001)), blood transfusion rate (OR=0.13[0.10,0.17], (P = 0.001), post-operative complications (OR=0.65[0.46,0.91], (P = 0.01)), and length of hospital stay (MD=-3.99[-4.67,-3.31], (P < 0.001)). While ORH was better than RRH regarding operation time (MD=15.34[2.21,28.47], (P = 0.02)) and number of resected lymph nodes (MD=-2.64[-4.12,-1.15], (P = 0.005)).

Conclusions

The previously seen increase in cancer recurrence and decrease in survival no longer seem to be present when we consider the newest high-quality data and exclude non-robotic minimally invasive techniques. RRH was associated with less estimated blood loss, a lower transfusion rate, a shorter hospital stay, and fewer postoperative complications. ORH seems to be associated with a higher number of resected lymph nodes, and a shorter operative time.

Trial registration details: Prospero Prospective Registration Number: CRD42022306991 Registration link: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=306991