BACKGROUND: The surgical management of mediastinal tumors in pediatric patients presents unique challenges due to the anatomical and physiological characteristics of this population. Video-assisted thoracoscopic surgery (VATS) has gained prominence as a minimally invasive alternative to open thoracotomy and median sternotomy (OT), offering potential benefits such as reduced postoperative pain and shorter recovery times. However, the relative effectiveness and safety of VATS compared to OT remain under debate. METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines, including retrospective studies comparing VATS and OT in pediatric patients undergoing mediastinal tumor resection. Statistical analyses were performed using random effects models, and heterogeneity was assessed with Cochran's Q-test and I RESULTS: Seven studies comprising 333 pediatric patients (41.7 % undergoing VATS and 58.2 % OT) met the inclusion criteria. VATS was associated with significantly reduced LOS (MD -3.23 days
95 % CI: -5.57 to -0.89
p <
0.01), complications (OR 0.40
95 % CI: 0.19 to 0.82
p = 0.01), intraoperative blood loss (MD -22.40 mL
95 % CI: -38.59 to -7.22
p <
0.01), and intraoperative blood transfusion (OR 0.08
95 % CI: 0.03 to 0.21
p <
0.01). No significant differences were observed between VATS and OT for recurrence (OR 0.37
95 % CI: 0.08 to 1.75
p = 0.21) or mortality (OR 0.25
95 % CI: 0.06 to 1.04
p = 0.06). CONCLUSION: The results of this meta-analysis, including 333 pediatric patients, suggest that VATS is associated with significant reductions in LOS, complication rates, intraoperative blood loss, and transfusion requirements compared to OT, without compromising oncological outcomes. VATS can be performed safely with a low LOS, but more complex tumors will still require open surgery. TRIAL REGISTRY: International Prospective Register of Systematic Reviews
Nº: CRD42025634968
URL: https://www.crd.york.ac.uk/prospero/.