Protocol for the systematic review and network meta-analysis of open versus video-assisted and robotic-assisted thymectomy for the treatment of thymic neoplasms

Abstract The surgical management of thymic neoplasms includes open and minimally invasive approaches. Previous studies have compared these techniques, but application in practice remains varied. This systematic review and network meta-analysis (NMA) will adhere to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist. MEDLINE, Embase, Cochrane Centrale and Scopus will be searched from inception to perform a systematic review, NMA and evidence appraisal using the Grading of Recommendations Assessment, Development and Evaluations and the Confidence in Network Meta-Analysis methodologies. Randomized controlled trials and cohort studies will be included. Full texts of any citation will be included if they assessed a minimum of two arms of any type of thymectomy technique, including open, video-assisted thoracoscopic surgery, or robotic-assisted thoracoscopic surgery thymectomy, for the treatment of thymic neoplasms such as thymoma, thymic carcinoma or thymic neuroendocrine tumors with or without myasthenia gravis. Studies assessing operative thymectomy techniques for benign disease will be excluded. Short- and long-term perioperative safety and oncologic outcomes will be compared between open versus video-assisted versus robotic-assisted thymectomy for the surgical management of thymic neoplasms. The Risk of Bias In Non-Randomized Studies—of Interventions tool will be used to assess the risk of bias in nonrandomized studies. We will conduct a frequentist fixed- and random-effects NMA using the graph theory approach for each outcome. Summary of odds ratios will be estimated for all dichotomous outcomes with their 95% confidence interval.