Comparison of open and minimally invasive nephrectomy for Wilms tumor: a systematic review and meta-analysis from the International Society of Pediatric Surgical Oncology.
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To compare the risks, complications, and feasibility of minimally invasive and open surgery for resection of Wilms tumor, we systematically reviewed comparative studies assessing the oncologic outcomes of minimally invasive (MIS) versus open surgery and performed both a meta-analysis and a critical assessment of the MIS surgical landscape in the field of pediatric urology. A systematic review of current literature was performed using PubMed, EMBASE, Google Scholar, Cochrane Collection, and Web of Science databases. Of 310 articles screened, a total of 9 studies (5 retrospective, 2 prospective, and 2 database/population-level retrospective reviews) were included in the meta-analysis. Heterogeneity was considered minimal between studies, and adjustments were made when necessary. Rates of intra-operative tumor spillage, positive margins, complications, recurrence, and survival were similar between MIS and classical open surgery. Mean length of hospital stay and operative times were significantly lower in MIS, with a mean difference of.96 days and 22.48 min, respectively (p < 0.001). The mean number of retrieved lymph nodes was significantly lower in MIS vs open surgery, with a difference of 3 nodes recorded (p = 0.003). Although lymph-node retrieval sampling was found to be reduced in MIS Wilms tumor resection, there were no differences in complications or post-operative outcomes when comparing MIS vs classical open surgery. We conclude that outcome metrics are considered equivalent in MIS and classical open surgery, though operative surgical times and total hospital stay are shorter with MIS resection. Further evidence-based prospective studies and quality reporting of lymph-node retrieval are crucially warranted as MIS becomes increasingly adopted.