Comparative outcomes of video-assisted thoracic surgery versus open thoracic surgery in pediatric pulmonary metastasectomy: a systematic review and meta-analysis.

Abstract

This meta-analysis aimed to compare the outcomes of video-assisted thoracic surgery (VATS) and open thoracotomy in pediatric patients undergoing pulmonary metastasectomy for various malignancies. We systematically searched PubMed, Embase, and Cochrane Library databases for studies comparing VATS and open thoracotomy in pediatric patients. The treatment effects for continuous outcomes were compared using mean differences (MDs), and binary endpoints were evaluated using odds ratios (ORs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I² statistics. Statistical analyses were performed using R software, version 4.4.1. A total of 4 studies involving 1,541 patients were included. There were no significant differences in overall survival (OR 0.65; 95% CI 0.36-1.18; p = 0.16) or disease-free survival (DFS) (OR 1.65; 95% CI 0.88-3.10; p = 0.12) between groups. However, VATS was associated with a significantly reduced length of hospital stay (MD -2.06 days; 95% CI - 2.93 to - 1.20; p < 0.01). This meta-analysis suggests that VATS significantly reduces hospitalization duration compared to open thoracotomy, with no significant difference in survival outcomes. Future prospective studies are needed to validate these findings and optimize patient selection criteria. International Prospective Register of Systematic Reviews; No: CRD42024581284; URL: https://www.crd.york.ac.uk/prospero/ .