Complications, recurrence, and survival rates for endometrial and cervical cancer treated by minimally invasive surgery: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Consensus is lacking regarding the relative safety and oncological outcomes of minimally invasive compared to abdominal hysterectomy. OBJECTIVES: To estimate complications and survival rates of minimally invasive hysterectomy (i.e., laparoscopic or robotic assisted) compared to total abdominal hysterectomy for endometrial and cervical cancer. METHODS: A systematic quantitative review of randomised controlled trials (RCTs) comparing minimally invasive hysterectomy with total abdominal hysterectomy (TAH) for the treatment of endometrial or cervical cancer. Medline-PubMed, Cochrane Library, Scopus, ongoing clinical trials and the grey literature were searched until December 1, 2024. MAIN OUTCOME MEASURES: Complications, overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates. RESULTS: Twenty-nine RCTs enrolling 6127 patients were included. The risk of bladder injury was higher in the minimally invasive hysterectomy group [risk ratio (RR): 1.84, 95% confidence interval: (CI): 1.03-3.29, I2: 0%), as was the risk of vaginal injury (RR: 12.39, 95% CI: 1.61-95.29, P=0.02, I2: 0%) but the risk of wound dehiscence was lower (RR: 0.32, 95% CI: 0.13-0.83, P=0.02, I2: 13%) compared to abdominal hysterectomy. Among cervical cancer patients, the risk for blood transfusion was significantly lower with the minimally invasive hysterectomy (RR: 0.42, 95% CI: 0.21-0.84, P=0.01, I2: 0%). Among endometrial cancer patients, the OS, DFS, and DSS were comparable between routes of hysterectomy. In contrast, the overall the OS and DFS rates were lower for minimally invasive compared to abdominal hysterectomy (0.94, 95% CI: 0.90-0.98, P=0.005, I2:0 %) and (0.89, 95% CI: 0.84-0.94, P<0.001, I2: 0%) respectively. CONCLUSIONS: Bladder and vaginal injuries are higher with minimally invasive compared to abdominal hysterectomy. Survival rates for endometrial cancer are comparable but for cervical cancer, minimally invasive hysterectomy is associated with poorer survival outcomes and this should be taken into account when counselling patients and deciding upon the route of hysterectomy. WHAT IS NEW?: TAH has superior survival outcomes compared to minimally invasive hysterectomy.