Minimally invasive partial nephrectomy versus open surgery in pediatric patients with duplex collecting system: A systematic review and meta-analysis

Abstract

Introduction: Partial nephrectomy (PN) is frequently performed in the management of symptomatic or poorly functioning renal moieties in pediatric patients with duplex collecting systems (DCS). Over the last decades, PN has shifted from open (OPN) to minimally invasive techniques, such as laparoscopic or robot-assisted surgery. However, evidence comparing minimally invasive PN (MIPN) to OPN in children with duplex kidneys remains limited.

Objective: We aimed to assess whether there is a difference between MIPN and OPN in children with DCS through a pairwise meta-analysis of perioperative outcomes.

Methods: We systematically searched PubMed, Embase, and Cochrane Library until September 2024 for studies comparing perioperative outcomes between MIPN and OPN in patients aged ≤18 years with DCS. Outcomes of interest included length of stay (LOS), operative time (OT), estimated blood loss (EBL), perioperative complications, and postoperative narcotic requirements. Odds ratios (OR), and mean differences (MD) were used for statistical comparisons. Data were analyzed using a random or fixed-effects model based on heterogeneity.

Results: Ten studies met inclusion criteria, totaling 304 patients: 159 received MIPN and 145 OPN. Pooled results revealed equivalent perioperative complication rates between the two groups (OR 0.80 [0.33; 1.94], p = 0.62). The MIPN group experienced longer OT when compared to OPN (MD 21.62 [3.72; 39.53], p = 0.01). However, reduced EBL (MD -16.87 [-22.33; -11.41], p=<0.0001), lower postoperative narcotic requirements (MD -1.21 [-1.75; -0.67], p=<0.0001), and shorter LOS (MD -2.16 [-3.15; -1.18], p=<0.0001) were observed with MIPN.

Conclusions: Compared to OPN, MIPN provides a comparable safety profile in terms of perioperative complications, while lowering postoperative narcotic requirements and reducing LOS, although longer OT with this technique is observed. MIPN is a feasible treatment modality for symptomatic DCS in children, although high-quality prospective studies are needed to draw definitive conclusions. Healthcare settings and parental preferences are also essential when managing this condition.

Keywords: Heminephrectomy; Kidney; Laparoscopy; Meta-analysis; Partial nephrectomy; Robotics.