Minimally invasive surgery versus open surgery for the treatment of solid abdominal and thoracic neoplasms in children: Cochrane systematic review
Assessed as up to date: 2011/08/07
Minimally invasive surgery (MIS) is an accepted surgical technique for the treatment of a variety of benign diseases. Presently, the use of MIS in patients with cancer is progressing. However, the role of MIS in children with solid neoplasms is less clear than it is in adults. Diagnostic MIS to obtain biopsy specimens for pathology has been accepted as a technique in paediatric surgical oncology, but there is limited experience with the use of MIS for the resection of malignancies.Objectives
To ascertain the differences in outcome between the minimally invasive and open approach in the treatment of solid intra-thoracic and intra-abdominal neoplasms in children, regarding overall survival, event-free survival, port-site metastases, recurrence rate and surgical morbidity.Search methods
We searched the electronic databases of MEDLINE/PubMed (from 1966 to February 2011), EMBASE/Ovid (from 1980 to February 2011) and CENTRAL (The Cochrane Library 2011, Issue 1) with pre-specified terms. In addition, we searched reference lists of relevant articles and reviews, conference proceedings and ongoing trial databases.Selection criteria
Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) comparing MIS and open surgery for the treatment of solid intra-thoracic or intra-abdominal neoplasms in children (aged 0 to 18 years).Data collection and analysis
Two authors performed the study selection independently.Main results
No studies that met the inclusion criteria of this review were identified.Authors' conclusions
No RCTs or CCTs evaluating MIS in the treatment of solid intra-thoracic or intra-abdominal neoplasms in children could be identified, therefore no definitive conclusions could be made about the effects of MIS in these patients. Based on the currently available evidence we are not able to give recommendations for the use of MIS in the treatment of solid intra-thoracic or intra-abdominal neoplasms in children. More high quality studies (RCTs and/or CCTs) are needed. To accomplish this, centres specialising in MIS in children should collaborate.
de Lijster Manou S, Bergevoet Rosemarijn M, van Dalen Elvira C, Michiels Erna MC, Caron Huib N, Kremer Leontien CM, Aronson Daniel C
Minimally invasive surgery (MIS) compared to open surgery for the treatment of solid tumours located in the chest or the abdomen of children
MIS is an upcoming new surgical technique, which is used as a diagnostic instrument (i.e. to retrieve biopsies) and is also used for the resection of tumours. However, there is limited experience with the use of MIS for the resection of tumours in children.
This systematic review focused on (randomised) controlled studies. The authors could not identify any randomised controlled trials (RCTs) or controlled clinical trials (CCTs) on this subject to support the therapeutic use of MIS in children with solid tumours in the chest or abdomen. More high quality studies are needed.
Implications for practice
Since no randomised controlled trials (RCTs) and controlled clinical trials (CCTs) evaluating the role of minimally invasive surgery (MIS) in solid intra-thoracic or intra-abdominal neoplasms in children are available, no definitive conclusions can be made about the effects on anti-tumour efficacy (i.e. overall survival (OS) and event-free survival (EFS)) and surgical morbidity of this treatment. Based on the currently available evidence, we are not able to give recommendations for clinical practice. MIS for solid intra-thoracic or intra-abdominal neoplasms in children currently must be regarded as an experimental treatment that should only be performed in the context of a trial. The role of MIS for paediatric solid tumours therefore remains a challenge and has yet to be defined.
Implications for research
We identified no RCTs or CCTs evaluating the role of MIS in solid intra-thoracic or intra-abdominal neoplasms in children. Before conclusions can be made about the effects on anti-tumour efficacy and surgical morbidity high quality RCTs and/or CCTs need to be undertaken. These RCTs and CCTs should be performed in homogeneous study populations (for example, with regard to tumour type and stage of disease). They should have a long-term follow up and the number of included patients should be sufficient to obtain the power needed for the results to be reliable. To obtain adequate numbers of patients, centres specialising in MIS in children should collaborate.Get full text at The Cochrane Library
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