A network meta-analysis of comparison of operative time and complications of laparoscopy, laparotomy, and laparoscopic-assisted vaginal hysterectomy for endometrial carcinoma

Abstract

Background: The endometrial carcinoma (EC) is the most frequently occurring female genital cancer. The authors performed this network meta-analysis to compare operative time and the incidence of bowel injury and wound infection of 3 operative approaches (laparoscopy, laparotomy, and laparoscopic-assisted vaginal hysterectomy [LAVH]) in the treatment of EC.

Methods: The Cochrane Library, PubMed, and Embase databases were searched. Randomized controlled trials (RCTs) for EC from the day of databases establishment to February 2017 were included. Direct and indirect evidences were combined to calculate the combined weighted mean difference (WMD) or odd ratio values and the surface under the cumulative ranking curve (SUCRA) value of 3 operative approaches in the treatment of EC.

Results: A total of 9 qualified RCTs were included into the study. The results showed that laparotomy had a shorter-operative time than LAVH (WMD = -40.36, 95% confidence interval = -75.03 to -2.57). However, there was no significant difference in the incidence of bowel injury and wound infection among 3 operative approaches. Besides, the SUCRA values indicated that laparotomy had the shortest operative time but the incidence of bowel injury and wound infection was relatively higher.

Conclusion: The results from this study indicate that laparotomy had highest incidence of bowel injury and wound infection but shortest operative time among 3 operative approaches in the treatment of EC.

Figure 1

Cochrane system bias evaluation of included studies. Nine eligible randomized controlled trials are analyzed in this network meta-analysis.

Figure 2

The funnel plot suggesting no existence of publication bias and studies included are of good quality. A = laparoscopy, B = laparotomy, C = laparoscopic-assisted vaginal hysterectomy.

Figure 3

Network evidence graphs for operative time, the incidence of bowel injury, and wound infection. LAVH = laparoscopic-assisted vaginal hysterectomy.

Figure 4

Relative relationship forest plots of the 3 surgical approaches as for operative time. A = laparoscopy, B = laparotomy, C = laparoscopic-assisted vaginal hysterectomy.

Figure 5

Diagrams of SUCRA values in terms of operative time, the incidence of bowel injury, and wound infection. SUCRA = surface under the cumulative ranking curves.