Robotic radical hysterectomy in early stage cervical cancer: A systematic review and meta-analysis

Objective: To compare intraoperative and short-term postoperative outcomes of robotic radical hysterectomy (RRH) to laparoscopic and open approaches in the treatment of early stage cervical cancer. Methods: A search of MEDLINE, EMBASE (using Ovid interface) and SCOPUS databases was conducted from database inception through February 15, 2014. We included studies comparing surgical approaches to radical hysterectomy (robotic vs. laparoscopic or abdominal, or both) in women with stages IA1-IIA cervical cancer. Intraoperative outcomes included estimated blood loss (EBL), operative time, number of pelvic lymph nodes harvested and intraoperative complications. Postoperative outcomes were hospital stay and surgical morbidity. The random effects model was used to pool weighted mean differences (WMDs) and odds ratios (OR). Results: Twenty six nonrandomized studies were included (10 RRH vs abdominal radical hysterectomy [ARH], 9 RRH vs laparoscopic radical hysterectomy [LRH] and 7 compared all 3 approaches) enrolling 4013 women (1013 RRH, 710 LRH and 2290 ARH). RRH was associated with less EBL (WMD = 384.3, 95% CI = 233.7, 534.8) and shorter hospital stay (WMD = 3.55, 95% CI = 2.10, 5.00) than ARH. RRH was also associated with lower odds of febrile morbidity (OR = 0.43, 95% CI = 0.20-0.89), blood transfusion (OR = 0.12, 95% CI 0.06, 0.25) and wound-related complications (OR = 0.31, 95% CI = 0.13, 0.73) vs. ARH. RRH was comparable to LRH in all intra- and postoperative outcomes. Conclusion: Current evidence suggests that RRH may be superior to ARH with lower EBL, shorter hospital stay, less febrile morbidity and wound-related complications. RRH and LRH appear equivalent in intraoperative and short-term postoperative outcomes and thus the choice of approach can be tailored to the choice of patient and surgeon.