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/.

查看原文本刊更多论文

电视辅助手术和开放手术在儿童纵隔肿瘤切除术中的比较：一项系统综述和荟萃分析

背景：由于儿童的解剖和生理特点，小儿纵隔肿瘤的手术治疗面临着独特的挑战。视频辅助胸腔镜手术（VATS）作为开放性开胸术和正中胸骨切开术（OT）的一种微创替代方法，具有减少术后疼痛和缩短恢复时间等潜在优势。然而，与OT相比，VATS的相对有效性和安全性仍存在争议。方法我们根据PRISMA指南进行了系统回顾和荟萃分析，包括比较VATS和OT在小儿纵隔肿瘤切除术中的回顾性研究。采用随机效应模型进行统计分析，采用Cochran’s q检验和I2统计量评估异质性。结果7项研究333例儿童患者（41.7%行VATS， 58.2%行OT）符合纳入标准。VATS与LOS显著降低相关(MD -3.23天；95% CI:−5.57 ~−0.89；p & lt;0.01)，并发症(OR 0.40；95% CI: 0.19 ~ 0.82；p = 0.01)，术中出血量(MD -22.40 mL；95% CI:−38.59 ~−7.22；p & lt;0.01)，术中输血(OR 0.08；95% CI: 0.03 ~ 0.21；p & lt;0.01)。VATS和OT的复发率无显著差异(OR 0.37；95% CI: 0.08 ~ 1.75；p = 0.21)或死亡率(or 0.25；95% CI: 0.06 ~ 1.04；p = 0.06)。这项荟萃分析的结果包括333名儿科患者，结果表明，与OT相比，VATS与显著降低LOS、并发症发生率、术中出血量和输血需求相关，且不影响肿瘤预后。在低LOS的情况下，VATS可以安全地进行，但更复杂的肿瘤仍需要开放手术。试验注册国际前瞻性系统评价注册；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.