Laparoscopy and laparotomy in endometrial cancer – a meta-analysis

Introduction: Uterine malignancies, the vast majority of which are endometrial cancers, constitute the most common type of gynecological neoplasms in developed countries. The primary treatment for endometrial cancer is hysterectomy and bilateral salpingoophorectomy. Women with endometrial cancer can be subjected to either total abdominal hysterectomy (TAH) or to an increasingly recommended total laparoscopic hysterectomy (TLH). We decided to verify whether published evidence supports TLH as an effective, less invasive than TAH albeit still equally radical treatment for endometrial malignancies. Material and methods: The systematic review included articles indexed in MEDLINE (PubMed) and EBSCO, published between January 1974 and January 2017. The search was based on the following keywords and combinations thereof: "laparoscopy", "laparotomy", "endometrial cancer", "comparative". Twenty-six full-text articles were included in the meta-analysis. Results: A total of 5,996 patients were eligible for the analysis, among them 2,833 (47.2%) women subjected to TLH and 3,163 (52.8%) who underwent TAH. Total laparoscopic hysterectomy is associated with shorter hospital stay, faster recovery, lesser blood loss and fewer intra- and postoperative blood transfusions, reduced pain, and a lower reoperation rate than conventional TAH. Conclusions: All analyzed studies demonstrated that TLH is a safe and effective treatment option in endometrial cancer patients. This procedure is markedly less invasive than TAH. However, considering several contraindications for laparoscopy, such as peritoneal invasion, cardiorespiratory failure, history of previous surgery and large size of the uterus, qualification for a given procedure needs to be preceded by a detailed evaluation.