Systematic review and national cancer database analysis of minimally invasive liver surgery in children.

INTRODUCTION

Despite the broader adoption of minimally invasive liver surgery (MILS) for adults, its application in the pediatric population has been mainly documented in single-center reports. We aimed to summarize the current state of evidence of MILS in children.

METHODS

We systematically reviewed PubMed, Scopus, Web of Science, and Cochrane Library databases according to the PRISMA statement for children (<18 years) undergoing MILS (end-of-search date: 03/03/2024). The National Cancer Database (NCDB) was queried for children (<18 years) undergoing MILS (2010-2021).

RESULTS

Forty-one articles reporting on 211 patients were included. The approach was laparoscopic in 91.5%, robotic in 5.7%, and hand-assisted 2.8%. The mean age was 5.4 ± 4.4 years, the mean lesion size was 6.2 ± 3.4 cm, and the most common indications were hepatoblastoma (28.9%) and hydatid cyst (27.0%). Most underwent cyst surgery (43.0%), followed by minor liver resection (37.7%). Five (2.4%) had conversion to open. The mean operative time was 162.1 ± 99.1 min and mean length of stay was 6.4 ± 4.9 days. Over a mean follow-up of 22.9 ± 24.6 months, one patient died (0.5%). Forty-six children underwent MILS in NCDB (45 laparoscopic, 1 robotic). The mean age was 4.7 ± 5.7 years and mean tumor size was 1.0 ± 1.3 cm. Most underwent wedge/segmental resection (47.8%). Five (10.9%) had conversion to open and mean length of stay was 6.3 ± 5.0 days.

CONCLUSION

This first systematic review and NCDB analysis establishes feasibility benchmarks of MILS in children for both benign and malignant liver lesions. MILS is associated with 2-11% conversion rate and mean length of stay of 6 days.

LEVEL OF EVIDENCE: Level III evidence.