Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis.
Emma R. Allanson,Aime Powell,Max Bulsara,Hong Lim Lee,Lynette Denny,Lynette Denny,Yee Leung,Paul A. Cohen +7 more
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TLDR
This is the first systematic review and meta-analysis of surgical morbidity in cervical cancer in LMIC, which highlights the limitations of the current data and provides a benchmark for future health services research and policy implementation.Abstract:
Objective
To investigate morbidity for patients after the primary surgical management of cervical cancer in low and middle-income countries (LMIC).
Methods
The Pubmed, Cochrane, the Cochrane Central Register of Controlled Trials, Embase, LILACS and CINAHL were searched for published studies from 1st Jan 2000 to 30th June 2017 reporting outcomes of surgical management of cervical cancer in LMIC. Random-effects meta-analytical models were used to calculate pooled estimates of surgical complications including blood transfusions, ureteric, bladder, bowel, vascular and nerve injury, fistulae and thromboembolic events. Secondary outcomes included five-year progression free (PFS) and overall survival (OS).
Findings
Data were available for 46 studies, including 10,847 patients from 11 middle income countries. Pooled estimates were: blood transfusion 29% (95%CI 0.19–0.41, P = 0.00, I2 = 97.81), nerve injury 1% (95%CI 0.00–0.03, I2 77.80, P = 0.00), bowel injury, 0.5% (95%CI 0.01–0.01, I2 = 0.00, P = 0.77), bladder injury 1% (95%CI 0.01–0.02, P = 0.10, I2 = 32.2), ureteric injury 1% (95%CI 0.01–0.01, I2 0.00, P = 0.64), vascular injury 2% (95% CI 0.01–0.03, I2 60.22, P = 0.00), fistula 2% (95%CI 0.01–0.03, I2 = 77.32, P = 0.00,), pulmonary embolism 0.4% (95%CI 0.00–0.01, I2 26.69, P = 0.25), and infection 8% (95%CI 0.04–0.12, I2 95.72, P = 0.00). 5-year PFS was 83% for laparotomy, 84% for laparoscopy and OS was 85% for laparotomy cases and 80% for laparoscopy.
Conclusion
This is the first systematic review and meta-analysis of surgical morbidity in cervical cancer in LMIC, which highlights the limitations of the current data and provides a benchmark for future health services research and policy implementation.read more
Citations
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Berek and Hacker's Gynecologic Oncology 5/e
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Incidence, Treatment and Outcomes of Cervical Cancer in Low- and Middle-income Countries
Umesh Mahantshetty,G. Lavanya,Surbhi Grover,C.A. Akinfenwa,Heloisa de Andrade Carvalho,Napapat Amornwichet +5 more
TL;DR: In this article, the authors highlight the incidence, treatment and clinical outcomes of cervical cancer in low-income (LICs) and low- and middle-income countries (LMIC) across Asia, South America, South Africa and Eastern Europe.
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Economic Perspective of Cancer Care and Its Consequences for Vulnerable Groups
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TL;DR: Overall, besides direct costs such as for treatment, many facets of indirect costs including survivorship costs for the cancer patients and their social environment need to be considered regarding the impact on vulnerability, treatment compliance and abundance.
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Survival after Laparoscopic versus Abdominal Radical Hysterectomy in Early Cervical Cancer: A Randomized Controlled Trial.
TL;DR: In this article, a single-center randomized controlled trial enrolled 30 patients with clinically staged IA2 cervical cancer and lymphovascular invasion, IB and IIA, who underwent laparoscopic radical hysterectomy (16) or abdominal radical hySTM (14) for treatment of early cervical cancer.
References
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