Comparing robotic, laparoscopic, and laparotomy in endometrial cancer: a network meta-analysis

Background: This study aims to assess the comparative effectiveness and safety of robotic-assisted surgery (RAS), laparoscopy (LPS), and laparotomy (LPT) in improving perioperative indicators, lymph node dissection, and tumor survival outcomes in patients with endometrial carcinoma (EC) through a systematic review and network meta-analysis (NMA). Materials and methods: We searched China National Knowledge Infrastructure, Wanfang, WeiPu, China Biology Medicine Disc, Embase, PubMed, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) and cohort studies (CSs) involving RAS, LPS and LPT in individuals with EC. The NMA employed a Bayesian framework to integrate direct and indirect evidence, calculating odds ratios (OR) and mean difference (MD). Markov chain Monte Carlo methods generated posterior distributions, comparing and ranking treatments using surface under the cumulative ranking (SUCRA) values. Regression and sensitivity analyses assessed the impact of different variables on the results. Results: 37 eligible trials involving 3 surgical techniques and 6,558 participants were included in this NMA. Our data showed that RAS was the most effective way for reducing estimated blood loss (MD −193; 95% CI [−279.38 to −106.95]; SUCRA 80.3%), length of hospital stay (MD −3.8; 95% CI [−5.37 to −2.31]; SUCRA 90.2%), transfusion rate (OR 0.13; 95% CI [0.06 to 0.28]; SUCRA 87%), intraoperative complications (OR 0.23; 95% CI [0.06 to 0.8]; SUCRA 91.3%), postoperative complications (OR 0.29; 95% CI [0.18 to 0.51]; SUCRA 98.8%), and total complications (OR 0.24; 95% CI [0.1 to 0.61]; SUCRA 96%). However, the analysis showed no significant differences in the dissection of lymph nodes and tumor survival outcomes. Conclusion: Our results showed that RAS was the most effective surgical method for improving perioperative indicators in EC. If hospital resources are limited, LPS is a suitable alternative. Further research is needed to confirm these findings and ensure that the benefits of minimally invasive surgeries extend to long-term survival outcomes.