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^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, 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. [ABSTRACT FROM AUTHOR]