Abstract：
Robotic-assisted laparoscopy (RALS) has gained widespread acceptance in the field of gynecological oncology. However, whether the prognosis of endometrial cancer after RALS is superior to conventional laparoscopy (CLS) and laparotomy (LT) remains inconclusive. Therefore, the aim of this meta-analysis was to compare the long-term survival outcomes of RALS with CLS and LT for endometrial cancer.
A systematic literature search was conducted on electronic databases (PubMed, Cochrane, EMBASE and Web of Science) until May 24, 2022, followed by a manual search. Based on inclusion and exclusion criteria, publications investigating long-term survival outcomes after RALS vs CLS or LT in endometrial cancer patients were collected. The primary outcomes included overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS) and disease-free survival (DFS). Fixed effects models or random effects models were employed to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) as appropriate. Heterogeneity and publication bias were also assessed.
RALS and CLS had no difference in OS (HR = 0.962, 95% CI: 0.922-1.004), RFS (HR = 1.096, 95% CI: 0.947-1.296), and DSS (HR = 1.489, 95% CI: 0.713-3.107) for endometrial cancer; however, RALS was significantly associated with favorable OS (HR = 0.682, 95% CI: 0.576-0.807), RFS (HR = 0.793, 95% CI: 0.653-0.964), and DSS (HR = 0.441, 95% CI: 0.298-0.652) when compared with LT. In the subgroup analysis of effect measures and follow-up length, RALS showed comparable or superior RFS/OS to CLS and LT. In early-stage endometrial cancer patients, RALS had similar OS but worse RFS than CLS.
RALS is safe in the management of endometrial cancer, with long-term oncological outcomes equivalent to CLS and superior to LT.
A systematic literature search was conducted on electronic databases (PubMed, Cochrane, EMBASE and Web of Science) until May 24, 2022, followed by a manual search. Based on inclusion and exclusion criteria, publications investigating long-term survival outcomes after RALS vs CLS or LT in endometrial cancer patients were collected. The primary outcomes included overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS) and disease-free survival (DFS). Fixed effects models or random effects models were employed to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) as appropriate. Heterogeneity and publication bias were also assessed.
RALS and CLS had no difference in OS (HR = 0.962, 95% CI: 0.922-1.004), RFS (HR = 1.096, 95% CI: 0.947-1.296), and DSS (HR = 1.489, 95% CI: 0.713-3.107) for endometrial cancer; however, RALS was significantly associated with favorable OS (HR = 0.682, 95% CI: 0.576-0.807), RFS (HR = 0.793, 95% CI: 0.653-0.964), and DSS (HR = 0.441, 95% CI: 0.298-0.652) when compared with LT. In the subgroup analysis of effect measures and follow-up length, RALS showed comparable or superior RFS/OS to CLS and LT. In early-stage endometrial cancer patients, RALS had similar OS but worse RFS than CLS.
RALS is safe in the management of endometrial cancer, with long-term oncological outcomes equivalent to CLS and superior to LT.
摘要：
目的：机器人辅助腹腔镜检查（RALS）在妇科肿瘤领域已获得广泛认可。然而,RALS术后子宫内膜癌的预后是否优于传统腹腔镜(CLS)和开腹手术(LT),目前尚无定论.因此,本荟萃分析的目的是比较RALS与CLS和LT治疗子宫内膜癌的长期生存结局.
方法：在电子数据库上进行了系统的文献检索(PubMed，科克伦,EMBASE和WebofScience），直到2022年5月24日，然后进行手动搜索。根据纳入和排除标准，收集了研究子宫内膜癌患者接受RALSvsCLS或LT治疗后长期生存结局的出版物.主要结果包括总生存期（OS），疾病特异性生存率（DSS），无复发生存期（RFS）和无病生存期（DFS）。采用固定效应模型或随机效应模型来计算合并风险比（HR）和95％置信区间（CI）。还评估了异质性和发表偏倚。
结果：RALS和CLS在OS上没有差异（HR=0.962，95％CI：0.922-1.004），RFS（HR=1.096，95%CI：0.947-1.296），和DSS（HR=1.489，95％CI：0.713-3.107）用于子宫内膜癌；然而，RALS与良好的OS显著相关(HR=0.682,95%CI:0.576-0.807),RFS（HR=0.793，95%CI：0.653-0.964），与LT相比，DSS（HR=0.441，95%CI：0.298-0.652）。在效应测量和随访时间的亚组分析中，RALS显示与CLS和LT相当或优于RFS/OS。在早期子宫内膜癌患者中，RALS的OS相似，但RFS比CLS差。
结论：RALS在子宫内膜癌的治疗中是安全的，长期肿瘤结局相当于CLS，优于LT。
方法：在电子数据库上进行了系统的文献检索(PubMed，科克伦,EMBASE和WebofScience），直到2022年5月24日，然后进行手动搜索。根据纳入和排除标准，收集了研究子宫内膜癌患者接受RALSvsCLS或LT治疗后长期生存结局的出版物.主要结果包括总生存期（OS），疾病特异性生存率（DSS），无复发生存期（RFS）和无病生存期（DFS）。采用固定效应模型或随机效应模型来计算合并风险比（HR）和95％置信区间（CI）。还评估了异质性和发表偏倚。
结果：RALS和CLS在OS上没有差异（HR=0.962，95％CI：0.922-1.004），RFS（HR=1.096，95%CI：0.947-1.296），和DSS（HR=1.489，95％CI：0.713-3.107）用于子宫内膜癌；然而，RALS与良好的OS显著相关(HR=0.682,95%CI:0.576-0.807),RFS（HR=0.793，95%CI：0.653-0.964），与LT相比，DSS（HR=0.441，95%CI：0.298-0.652）。在效应测量和随访时间的亚组分析中，RALS显示与CLS和LT相当或优于RFS/OS。在早期子宫内膜癌患者中，RALS的OS相似，但RFS比CLS差。
结论：RALS在子宫内膜癌的治疗中是安全的，长期肿瘤结局相当于CLS，优于LT。
