Comparison of survival outcomes between robotic and laparoscopic radical hysterectomies for early-stage cervical cancer: a systemic review and meta-analysis

Abstract

Objective: Survival outcomes of robotic radical hysterectomy (RRH) remain controversial. Therefore, we performed a meta-analysis to evaluate survival outcomes between RRH) and laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer.

Methods: Studies comparing between RRH and LRH published up to November 2022 were systemically searched in the PubMed, Cochrane Library, Web of Science, ScienceDirect, and Google Scholar databases. Manual searches of related articles and relevant bibliographies of the published studies were also performed. Two researchers independently extracted data. Studies with information on recurrence and death after minimally invasive radical hysterectomy were also included. The extracted data were analyzed using the Stata MP software package version 17.0.

Results: Twenty eligible clinical trials were included in the meta-analysis. When all studies were pooled, the odds ratios of RRH for recurrence and death were 1.19 (95% confidence interval [CI]=0.91-1.55; p=0.613; I²=0.0%) and 0.96 (95% CI=0.65-1.42; p=0.558; I²=0.0%), respectively. In a subgroup analysis, the quality of study methodology, study size, country where the study was conducted, and publication year were not associated with survival outcomes between RRH and LRH.

Conclusion: This meta-analysis demonstrates that the survival outcomes are comparable between RRH and LRH.

Trial registration: International Prospective Register of Systematic Reviews Identifier: CRD42023387916.

Keywords: Hysterectomy; Laparoscopy; Robotic Surgical Procedures; Survival Analysis; Uterine Cervical Neoplasm.

Fig. 1. Flow diagram to identify relevant studies for the meta-analysis.

Fig. 2. The forest plot shows the incidence of recurrences of RRH compared to LRH in a fixed-effect model of 20 studies. No significant between-study heterogeneity was detected (I²=0.0%; p=0.613) (OR=1.19; 95% CI=0.91–1.55; p=0.204).

CI, confidence interval; LRH, laparoscopic radical hysterectomy; OR, odd ratio; RRH, robotic radical hysterectomy.

Fig. 3. The forest plot shows the incidence of deaths of RRH compared to LRH in a fixed-effect model of 18 studies. No significant between-study heterogeneity was detected (I²=0.0%; p=0.558) (OR=0.96; 95% CI=0.64–1.42; p=0.827).

CI, confidence interval; LRH, laparoscopic radical hysterectomy; OR, odd ratio; RRH, robotic radical hysterectomy.

Fig. 4. Funnel plots of the incidence of recurrences (A) and deaths (B) of robotic radical hysterectomy compared to laparoscopic radical hysterectomy.