Objective: To define, if any, type I clinical evidence regarding the safety and efficacy of the laparoscopic approach to endometrial cancer.
Methods: Meta-analysis of randomized controlled trials (RCTs).
Results: Four RCTs were identified and included in the final analysis. No significant difference between laparoscopic and laparotomic approaches to endometrial cancer in overall [odds ratio (OR)=0.80, 95%CI 0.37 to 1.70, P=0.695], disease-free (OR=0.76, 95%CI 0.34 to 1.72, P=0.655), and cancer-related (OR=0.89, 95%CI 0.19 to 4.13, P=0.815) survival was observed. Significantly longer operative time (OR=53.48, 95%CI 37.28 to 69.68, P=0.0002), lower intraoperative blood loss (OR=-266.86, 95%CI -454.82 to -78.90, P=0.005) and postoperative complications (OR=0.40, 95%CI 0.23 to 0.70, P=0.007) were associated to laparoscopy. No effect of laparoscopy on pelvic (OR=0.62, 95%CI -1.47 to 2.71, P=0.560) and para-aortic (OR=1.49, 95%CI -2.49 to 5.60, P=0.477) nodes yield, and intraoperative complications (OR=1.60, 95%CI 0.49 to 5.22, P=0.390) was observed.
Conclusions: Even if limited by few RCTs with short-term follow-up, our data suggest that laparoscopic approach should be considered an effective and safe procedure for patients with early stage endometrial cancer as well as laparotomic one. Notwithstanding the longer operative time, advantages of the laparoscopy over traditional laparotomy regard intraoperative blood loss and postoperative complications.