Comparison of laparoscopy and laparotomy for endometrial cancer

Objective: To compare the safety and efficacy of laparoscopy and laparotomy on clinical outcomes among patients with endometrial cancer. Methods: Eligible randomized controlled trials (RCTs) conducted between 1966 and June 2010 were analyzed by meta-analysis. Results: Eight 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% Cl, 0.50-1.82; P=0.892), or cancer-related (OR, 0.90; 95% Cl, 0.27-3.08; P=0.871) survival. More intraoperative complications (OR, 1.33; 95% Cl, 1.03-1.73; P=0.030), fewer postoperative complications (OR, 0.59; 95% Cl, 0.46-0.75; P<0.001), longer operative time (standardized mean difference [SMD], 0.80; 95% Cl, 0.46-1.15; P<0.001), lower blood loss (SMD, -2.29; 95% Cl, -3.67 to -0.91; P=0.001), and shorter hospital stay (SMD, -2.60; 95% Cl, -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% Cl, -0.04 to 1.11; P=0.067) lymph node yield. Conclusion: Laparoscopy has short-term advantages and seemingly equivalent long-term outcomes and, in experienced hands, might be a feasible alternative to laparotomy for endometrial cancer. (C) 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.