Background: Total hysterectomy with bilateral salpingo-oophorectomy via minimally invasive surgery (MIS) has emerged as the standard of care for early-stage endometrial cancer (EC). Prior systematic reviews and meta-analyses have focused on outcomes reported solely from randomised controlled trials (RCTs), overlooking valuable data from non-randomised studies. This inaugural systematic review and network meta-analysis comprehensively compares clinical and oncological outcomes between MIS and open surgery for early-stage EC, incorporating evidence from randomised and non-randomised studies.Methods: This study was prospectively registered on PROSPERO (CRD42020186959). All original research of any experimental design reporting clinical and oncological outcomes of surgical treatment for endometrial cancer was included. Study selection was restricted to English-language peer-reviewed journal articles published 1 January 1995–31 December 2021. A Bayesian network meta-analysis was conducted.Results: A total of 99 studies were included in the network meta-analysis, comprising 181,716 women and 14 outcomes. Compared with open surgery, laparoscopic and robotic-assisted surgery demonstrated reducedblood lossandlength of hospital staybut increasedoperating time. Compared with laparoscopic surgery, robotic-assisted surgery was associated with a significant reduction inileus(OR = 0.40, 95% CrI: 0.17–0.87) andtotal intra-operative complications(OR = 0.38, 95% CrI: 0.17–0.75) as well as a higherdisease-free survival(OR = 2.45, 95% CrI: 1.04–6.34).Conclusions: For treating early endometrial cancer, minimal-access surgery via robotic-assisted or laparoscopic techniques appears safer and more efficacious than open surgery. Robotic-assisted surgery is associated with fewer complications and favourable oncological outcomes.
背景：通过微创手术（MIS）进行的全子宫及双侧输卵管卵巢切除术已成为早期子宫内膜癌（EC）的标准治疗方案。既往的系统综述和荟萃分析主要关注随机对照试验（RCT）报告的结果，忽视了非随机研究中的宝贵数据。本项开创性的系统综述和网络荟萃分析全面比较了微创手术与开腹手术治疗早期子宫内膜癌的临床和肿瘤学结果，整合了随机和非随机研究的证据。 方法：本研究已在PROSPERO前瞻性注册（CRD42020186959）。纳入所有报告子宫内膜癌手术治疗临床和肿瘤学结果的任何实验设计的原始研究。研究筛选限于1995年1月1日至2021年12月31日期间发表的英文同行评审期刊文章。进行了贝叶斯网络荟萃分析。 结果：网络荟萃分析共纳入99项研究，涉及181,716名女性患者和14项结局指标。与开腹手术相比，腹腔镜手术和机器人辅助手术显示出**失血量减少**和**住院时间缩短**，但**手术时间延长**。与腹腔镜手术相比，机器人辅助手术与**肠梗阻**（OR = 0.40，95% CrI：0.17–0.87）和**总术中并发症**（OR = 0.38，95% CrI：0.17–0.75）的显著减少相关，并且具有更高的**无病生存率**（OR = 2.45，95% CrI：1.04–6.34）。 结论：对于治疗早期子宫内膜癌，通过机器人辅助或腹腔镜技术进行的微创手术似乎比开腹手术更安全、更有效。机器人辅助手术与更少的并发症和更优的肿瘤学结局相关。
肿瘤(癌症)患者之家