Survival after minimally invasive radical hysterectomy without using uterine manipulator for early‐stage cervical cancer: A systematic review and meta‐analysis

Abstract Background Minimally invasive radical hysterectomy has been reported to increase the risk of cancer relapse and death compared with open surgery in women with early‐stage cervical cancer. The use of a uterine manipulator is considered one of the risk factors. Objectives To investigate whether women with early‐stage cervical cancer treated with minimally invasive radical hysterectomy without using uterine manipulator have oncological outcomes similar to those of open surgery. Search strategy Searches were performed in MEDLINE, Embase and CENTRAL from their inception until 31 March 2022. Selection criteria Inclusion criteria were: (1) randomised controlled trials or observational cohort studies published in English, (2) studies comparing minimally invasive radical hysterectomy without using a uterine manipulator with open radical hysterectomy in women with early‐stage cervical cancer, and (3) studies comparing survival outcomes. Data collection and analysis Two authors independently conducted data extraction and assessed study quality. We calculated the hazard ratios (HR) and the 95% confidence intervals (CI) using the inverse variance approach for survival outcome. Main results Six observational studies with 2150 women were included. The minimally invasive surgery group had a significantly higher risk of cancer relapse compared with open surgery group (HR 1.55, 95% CI 1.15–2.10). Conclusions Minimally invasive radical hysterectomy without using a uterine manipulator resulted in an inferior recurrence‐free survival compared with open radical hysterectomy in the treatment of women with early‐stage cervical cancer.