Systematic Review and Meta-analysis of Laparoscopic Versus Open Radical Nephrectomy for Paediatric Renal Tumours with Focus on Wilms' Tumour.

OBJECTIVE: To summarize and evaluate the outcomes of laparoscopic radical nephrectomy (LRN) and compare its safety and efficacy with open radical nephrectomy (ORN) in paediatric renal tumours (RT) and Wilms' tumour (WT).

SUMMARY BACKGROUND DATA: ORN is the gold standard treatment for paediatric RT, consisting predominantly of WT. LRN is gaining popularity but remains controversial in paediatric surgical oncology.

METHODS: Systematic search was performed for all eligible studies on LRN and comparative studies between LRN and ORN in paediatric RT and WT. Meta-analysis, subgroup analysis and sensitivity analysis were conducted. Main endpoints were the cancer-related outcomes and surgical morbidity. PRISMA guidelines were followed.

RESULTS: No level I-II studies were identified. LRN was feasible in nearly 1 in 5 paediatric RT and WT after neoadjuvant chemotherapy, with pooled mid-term oncological outcomes (<7% local recurrence, >90% event-free survival) comparable with those of ORN. There was no strong evidence of increased risk of intraoperative tumour spillage, but lymph node harvest was inadequate in LRN. Large tumours crossing the ipsilateral spinal border were associated with a trend for intraoperative complications and positive margins. Pooled complications rate and hospital stay duration were similar between LRN and ORN. Long-term (>3-year) outcomes are unknown.

CONCLUSIONS: Available level III evidence indicates that LRN is a safe alternative to ORN for carefully selected cases, with similar spillage rates and mid-term oncological outcomes. However, there was no advantage in surgical morbidity and lymph node harvest was inadequate with LRN. Tumour matched-group studies with long-term follow-up are required.

LEVEL OF EVIDENCE: III.