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Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis
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 1...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6608935/ https://www.ncbi.nlm.nih.gov/pubmed/31269024 http://dx.doi.org/10.1371/journal.pone.0217775 |
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author | Allanson, Emma R. Powell, Aime Bulsara, Max Lee, Hong Lim Denny, Lynette Leung, Yee Cohen, Paul |
author_facet | Allanson, Emma R. Powell, Aime Bulsara, Max Lee, Hong Lim Denny, Lynette Leung, Yee Cohen, Paul |
author_sort | Allanson, Emma R. |
collection | PubMed |
description | 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 1(st) Jan 2000 to 30(th) 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, I(2) = 97.81), nerve injury 1% (95%CI 0.00–0.03, I(2) 77.80, P = 0.00), bowel injury, 0.5% (95%CI 0.01–0.01, I(2) = 0.00, P = 0.77), bladder injury 1% (95%CI 0.01–0.02, P = 0.10, I(2) = 32.2), ureteric injury 1% (95%CI 0.01–0.01, I(2) 0.00, P = 0.64), vascular injury 2% (95% CI 0.01–0.03, I(2) 60.22, P = 0.00), fistula 2% (95%CI 0.01–0.03, I(2) = 77.32, P = 0.00,), pulmonary embolism 0.4% (95%CI 0.00–0.01, I(2) 26.69, P = 0.25), and infection 8% (95%CI 0.04–0.12, I(2) 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. |
format | Online Article Text |
id | pubmed-6608935 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-66089352019-07-12 Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis Allanson, Emma R. Powell, Aime Bulsara, Max Lee, Hong Lim Denny, Lynette Leung, Yee Cohen, Paul PLoS One Research Article 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 1(st) Jan 2000 to 30(th) 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, I(2) = 97.81), nerve injury 1% (95%CI 0.00–0.03, I(2) 77.80, P = 0.00), bowel injury, 0.5% (95%CI 0.01–0.01, I(2) = 0.00, P = 0.77), bladder injury 1% (95%CI 0.01–0.02, P = 0.10, I(2) = 32.2), ureteric injury 1% (95%CI 0.01–0.01, I(2) 0.00, P = 0.64), vascular injury 2% (95% CI 0.01–0.03, I(2) 60.22, P = 0.00), fistula 2% (95%CI 0.01–0.03, I(2) = 77.32, P = 0.00,), pulmonary embolism 0.4% (95%CI 0.00–0.01, I(2) 26.69, P = 0.25), and infection 8% (95%CI 0.04–0.12, I(2) 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. Public Library of Science 2019-07-03 /pmc/articles/PMC6608935/ /pubmed/31269024 http://dx.doi.org/10.1371/journal.pone.0217775 Text en © 2019 Allanson et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Allanson, Emma R. Powell, Aime Bulsara, Max Lee, Hong Lim Denny, Lynette Leung, Yee Cohen, Paul Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis |
title | Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis |
title_full | Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis |
title_fullStr | Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis |
title_full_unstemmed | Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis |
title_short | Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis |
title_sort | morbidity after surgical management of cervical cancer in low and middle income countries: a systematic review and meta-analysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6608935/ https://www.ncbi.nlm.nih.gov/pubmed/31269024 http://dx.doi.org/10.1371/journal.pone.0217775 |
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