Abstract:

Objective To compare the efficacy and safety of laparoscopy and laparotomy for treating endometrial cancer. Methods The Cochrane Central Register of Controlled Trials （CENTRAL，issue 3） and the databases of Medline，Embase，PubMed，CBM，CNKI，Wan Fang and VIP were searched to identify randomized controlled trials（RCTs） published before March 2016 comparing laparoscopic and laparotomic approaches to treat endometrial cancer of any stage. Unpublished and grey literature，reference lists in relevant articles，gynecological cancer handbooks and conference abstracts were also searched. Two reviewers independently screened the literature according to inclusion and exclusion criteria，and methodological quality was evaluated. Pooled data were meta-analyzed using RevMan 5.1. Results The review included 9 studies involving 3616 endometrial cancer patients. Laparoscopic surgery was superior to laparotomy in terms of shorter hospital stay（MD=-3.42，95%CI -3.81 to -3.03，P＜0.001） and lower rate of post-operative complications（OR=0.62，95%CI 0.52 to 0.73，P＜0.001），but it was inferior to laparotomy in terms of higher rate of intra-operative complications（OR=1.35，95%CI 1.05 to 1.74，P=0.02） and longer surgical time （MD＝32.73，95%CI16.34 to 49.13，P＜0.01）. The two approaches were similar in terms of overall survival，disease-free survival，recurrence and pelvic node yield（P＞0.05）. Conclusions Laparoscopic surgery may be superior to laparotomy for many women with endometrial cancer，particularly in terms of post-operative complications and length of hospital stay. Additional well-designed RCTs are needed to compare long-term clinical outcomes，particularly quality of life，between the two approaches.

Key words: Uterine neoplasm, Endometrial cancer, Laparoscopy, Laparotomy, Randomized controlled trial, Systematic review, Efficacy, Quality of life