Minimally invasive approaches to primary cardiac tumors: a systematic
review and meta-analysis.
Objective: Cardiac tumors are rare conditions. The vast majority of them
are benign yet they may lead to serious complications. Complete surgical
resection is the gold standard treatment and should be performed as soon
as the diagnosis is made. Median sternotomy (MS) is the standard
approach and provides excellent early outcomes and durable results at
follow-up. However, minimally invasive (MI) is gaining popularity and
its role in the treatment of cardiac tumors needs further clarification.
Methods: A systematic literature review identified 12 candidate studies;
of these, 11 met the meta-analysis criteria. We analyzed outcomes of 653
subjects (294 MI and 359 MS) with random effects modeling. Each study
was assessed for heterogeneity. The primary endpoints were mortality at
follow-up and tumor relapse. Secondary endpoints included relevant
intra- and post-operative outcomes; tumor size was also considered.
Results: There were no significant between-group differences in terms of
late mortality (incidence rate ratio (IRR): MI vs. MS, 0.98 [95% CI:
0.25¬–3.82], p = 0.98). Few relapses and redo surgery were observed
in both groups (IRR: 1.13[0.26-4.88], p=0.87);( IRR: 1.92 [95%
CI: 0.39-9.53], p=0.42); MI was associated to prolonged operation time
yet with no effects on clinical outcomes. Tumor size did not
significantly differ between groups. Conclusions: Both MI and MS are
associated with excellent early and late outcomes with acceptable
survival rate and low incidence of recurrences. This study confirms that
cardiac tumor may be approached safely and radically with a MI approach.