van der Perk M E Madeleine, van der Kooi Anne-Lotte L F, Broer Simone L, Mensink Maarten O, Bos Annelies M E, van de Wetering Marianne D, van der Steeg Alida F W, van den Heuvel-Eibrink Marry M
Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
Department of Obstetrics and Gynecology, Erasmus MC-University Medical Center, Rotterdam, Netherlands.
Front Oncol. 2024 May 28;14:1315747. doi: 10.3389/fonc.2024.1315747. eCollection 2024.
Infertility is an important late effect of childhood cancer treatment. Ovarian tissue cryopreservation (OTC) is established as a safe procedure to preserve gonadal tissue in (pre)pubertal girls with cancer at high risk for infertility. However, it is unclear whether elective laparoscopic OTC can also be performed safely in infants <1 year with cancer. This systematic review aims to evaluate the reported risks in infants undergoing elective laparoscopy regarding mortality, and/or critical events (including resuscitation, circulatory, respiratory, neurotoxic, other) during and shortly after surgery.
This systematic review followed the Preferred reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting guideline. A systematic literature search in the databases Pubmed and EMbase was performed and updated on February 15, 2023. Search terms included 'infants', 'intubation', 'laparoscopy', 'mortality', 'critical events', 'comorbidities' and their synonyms. Papers published in English since 2000 and describing at least 50 patients under the age of 1 year undergoing laparoscopic surgery were included. Articles were excluded when the majority of patients had congenital abnormalities. Quality of the studies was assessed using the QUIPS risk of bias tool.
The Pubmed and Embase databases yielded a total of 12,401 unique articles, which after screening on title and abstract resulted in 471 articles to be selected for full text screening. Ten articles met the inclusion criteria for this systematic review, which included 1778 infants <1 years undergoing elective laparoscopic surgery. Mortality occurred once (death not surgery-related), resuscitation in none and critical events in 53/1778 of the procedures.
The results from this review illustrate that morbidity and mortality in infants without extensive comorbidities during and just after elective laparoscopic procedures seem limited, indicating that the advantages of performing elective laparoscopic OTC for infants with cancer at high risk of gonadal damage may outweigh the anesthetic and surgical risks of laparoscopic surgery in this age group.
不孕是儿童癌症治疗的一种重要晚期效应。卵巢组织冷冻保存（OTC）已被确立为一种安全的程序，用于在有不孕高风险的癌症（青春期前）女孩中保存性腺组织。然而，尚不清楚择期腹腔镜下OTC是否也能在1岁以下患癌婴儿中安全进行。本系统评价旨在评估接受择期腹腔镜手术的婴儿在手术期间及术后不久的死亡和/或严重事件（包括复苏、循环、呼吸、神经毒性、其他）的报告风险。
本系统评价遵循系统评价和Meta分析的首选报告项目（PRISMA）报告指南。在数据库Pubmed和EMbase中进行了系统的文献检索，并于2023年2月15日更新。检索词包括“婴儿”、“插管”、“腹腔镜检查”、“死亡率”、“严重事件”、“合并症”及其同义词。纳入2000年以来发表的、描述至少50例1岁以下接受腹腔镜手术患者的英文论文。当大多数患者有先天性异常时，排除相关文章。使用QUIPS偏倚风险工具评估研究质量。
Pubmed和Embase数据库共产生12401篇独特文章，经标题和摘要筛选后，有471篇文章被选入全文筛选。10篇文章符合本系统评价的纳入标准，其中包括1778例1岁以下接受择期腹腔镜手术的婴儿。发生1例死亡（与手术无关），无复苏情况，53/1778例手术发生严重事件。
本评价结果表明，在择期腹腔镜手术期间及术后不久，无广泛合并症的婴儿的发病率和死亡率似乎有限，这表明对性腺损伤高风险的癌症婴儿进行择期腹腔镜OTC的益处可能超过该年龄组腹腔镜手术的麻醉和手术风险。
