Comparison of Video-assisted Surgery and Open Surgery for Mediastinal Tumor Resection in Pediatric Population: A Systematic Review and Meta-analysis

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-03-04 DOI:10.1016/j.jpedsurg.2025.162271

Rachid Eduardo Noleto da Nobrega Oliveira , Isabella Cabianca Moriguchi Caetano Salvador , Felipe S. Passos , Lucas Antônio Fernandes Torres , Maria Tereza Camarotti

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引用次数: 0

Abstract

Background

The surgical management of mediastinal tumors in pediatric patients presents unique challenges due to the anatomical and physiological characteristics of this population. Video-assisted thoracoscopic surgery (VATS) has gained prominence as a minimally invasive alternative to open thoracotomy and median sternotomy (OT), offering potential benefits such as reduced postoperative pain and shorter recovery times. However, the relative effectiveness and safety of VATS compared to OT remain under debate.

Methods

We conducted a systematic review and meta-analysis following PRISMA guidelines, including retrospective studies comparing VATS and OT in pediatric patients undergoing mediastinal tumor resection. Statistical analyses were performed using random effects models, and heterogeneity was assessed with Cochran's Q-test and I² statistics.

Results

Seven studies comprising 333 pediatric patients (41.7 % undergoing VATS and 58.2 % OT) met the inclusion criteria. VATS was associated with significantly reduced LOS (MD -3.23 days; 95 % CI: −5.57 to −0.89; p < 0.01), complications (OR 0.40; 95 % CI: 0.19 to 0.82; p = 0.01), intraoperative blood loss (MD -22.40 mL; 95 % CI: −38.59 to −7.22; p < 0.01), and intraoperative blood transfusion (OR 0.08; 95 % CI: 0.03 to 0.21; p < 0.01). No significant differences were observed between VATS and OT for recurrence (OR 0.37; 95 % CI: 0.08 to 1.75; p = 0.21) or mortality (OR 0.25; 95 % CI: 0.06 to 1.04; p = 0.06).

Conclusion

The results of this meta-analysis, including 333 pediatric patients, suggest that VATS is associated with significant reductions in LOS, complication rates, intraoperative blood loss, and transfusion requirements compared to OT, without compromising oncological outcomes. VATS can be performed safely with a low LOS, but more complex tumors will still require open surgery.

Trial Registry

International Prospective Register of Systematic Reviews; Nº: CRD42025634968; URL: https://www.crd.york.ac.uk/prospero/.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.