Summary of findings for the main comparison. Laparoscopy versus laparotomy for early stage endometrial cancer.
| Laparoscopy versus laparotomy for early stage endometrial cancer | ||||||
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Patient or population: adult women diagnosed with early stage (I to IIa) endometrial cancer undergoing surgery as primary treatment. Settings: randomised controlled trials (RCTs) Intervention: laparotomy, total abdominal hysterectomy (TAH) Comparison: laparoscopy; laparoscopically assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Laparoscopy | Laparotomy | |||||
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Overall survival (survival until death from all causes) |
Not estimable due to reporting of HR and heterogeneous length of follow‐up across trials. We did not arbitrarily choose a snap shot in time in which to use as basis to calculate the assumed and corresponding risks as this may be misleading. |
HR 1.04 (0.86 to 1.25) |
3993 participants (6 studies) |
⊕⊕⊕⊝ Moderatea,b | The overall certainty of evidence for this outcome was moderate and was downgraded for unclear risk of bias profiles and imprecision (although most trials used adequate methods of sequence generation and concealment of allocation). | |
| Recurrence free survival | Not estimable due to reporting of HR and heterogeneous length of follow‐up across trials. We did not arbitrarily choose a snap shot in time in which to use as basis to calculate the assumed and corresponding risks as this may be misleading. |
HR 1.14 (0.90 to 1.43) |
3710 participants (5 studies) |
⊕⊕⊕⊝ Moderatea,b | The overall certainty of evidence for this outcome was moderate and was downgraded for unclear risk of bias profiles and imprecision (although most trials used adequate methods of sequence generation and concealment of allocation). | |
| Serious adverse events (range of outcomes) | Generally low proportion of event rates so assumed risks were not computed. | RRs were not statistically significant for any of the adverse event outcomes. Estimated blood loss was statistically significant on a continuous scale but the difference was not clinically important (MD –108.6 mL (95% CI –141.59 to –72.06). | Range 313 to 3894 (2 to 8 studies) |
⊕⊕⊝⊝ Lowa,b,c | The overall certainty of evidence for this outcome was low and was downgraded for unclear risk of bias profiles, imprecision and low event rates (although most trials used adequate methods of sequence generation and concealment of allocation). | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HR: hazard ratio; MD: mean difference; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate. | ||||||
aDowngraded (by half a point) for uncertainty in a number of potential biases in included trials due to their unclear risk of bias profiles. bDowngraded (by half a point) for imprecision in effect estimates. cDowngraded for low event rates and low power in the adverse event analyses.