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Minimally invasive versus open surgery for pediatric Wilms tumor: A systematic review and meta-analysis under SIOP
Natalia A C Lacerda1, Bianca R Rosa2, Letícia S Dos Santos3
1Barretos School of Health Sciences "Dr Paulo Prata" (FACISB), Barretos, SP, Brazil.
Background:
Despite technological advances in minimally invasive surgery for pediatric oncology over recent decades and the fundamental role of surgery in Wilms tumor (WT) management, there are no standardized guidelines for these techniques in this population. This study compares outcomes between laparoscopic nephrectomy (LN) and open nephrectomy (ON) in pediatric patients with WT treated under the International Society of Paediatric Oncology (SIOP) protocol.
Methods:
A systematic review and meta-analysis were conducted. Inclusion criteria encompassed randomized trials or nonrandomized cohorts comparing LN to ON, with patients treated according to the SIOP protocol. Clinical outcomes, including mortality, surgical morbidity, and oncological outcomes, were analyzed.
Results:
Four nonrandomized cohort studies comprising 160 patients (60 LN, 100 ON) met the inclusion criteria. LN was associated with longer surgical times (mean difference, 23.79 min; p = 0.0002). There were no statistically significant differences between groups in postoperative complications (RR 0.56, p = 0.44), disease recurrence (RR 0.49, p = 0.26), mortality (RR 0.75, p = 0.70), local recurrence (RR 0.58, p = 0.45), or lymph node harvest (mean difference -2.71 nodes, p = 0.06).
Conclusion:
Laparoscopic nephrectomy provides comparable oncological outcomes to open nephrectomy in pediatric WT. While numerical differences were observed in some outcomes, they did not reach statistical significance, likely due to the limited sample size.
