Robot-assisted versus conventional minimally invasive surgery in the treatment of paediatric neuroblastoma: a single-centre retrospective study

Introduction: Neuroblastoma is the most common extracranial solid tumour in childhood. Although minimally invasive surgery (MIS) is increasingly used in selected patients with neuroblastic tumours, comparative data between robot-assisted and conventional MIS are lacking. Materials and methods: A single-centre retrospective study was conducted on 84 patients who underwent minimally invasive resection of neuroblastic tumours between 2008 and 2025. Patients were divided into conventional MIS and robot-assisted surgery groups. Demographic data, tumour characteristics and surgical and oncological outcomes were compared. Results: The robot-assisted group included a higher number of patients with Image-Defined Risk Factor (IDRF) ≥ 1 (57% vs. 8%). Robotic surgery was therefore preferentially employed in more complex cases, resulting in higher conversion rate and longer operative time. Despite the higher prevalence of patients with IDRF ≥ 1 in the robotic group, intraoperative and postoperative complication rates were comparable between groups. Notably, conversions were not performed for emergency reasons but were based on intraoperative decision-making. Conclusions: Robot-assisted surgery may safely expand selection criteria to selected patients with positive IDRFs, while maintaining oncological principles and without increasing intra and postoperative morbidity.