Abstract
BackgroundTo compare the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy with those of retroperitoneal laparoscopic adrenalectomy for patients with pheochromocytoma.MethodsWe searched PubMed, EMBASE and the Cochrane Central Register for studies from 1999 to 2019 to assess the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy and the retroperitoneal approach for laparoscopic adrenalectomy in patients with pheochromocytoma. After data extraction and quality assessments, we used RevMan 5.2 to pool the data.ResultsFour retrospective studies were obtained in our meta-analysis. Patients who underwent retroperitoneal laparoscopic adrenalectomy were associated with shorter operative time (WMD: 34.91, 95% CI: 27.02 to 42.80, I2 = 15%; p < 0.01), less intraoperative blood loss (WMD: 139.32, 95% CI: 125.38 to 153.26, I2 = 0, p < 0.01), and a shorter hospital stay (WMD: 2, 95% CI: 1.18 to 2.82, I2 = 82%, p < 0.01) than patients who underwent transperitoneal laparoscopic adrenalectomy. No significant differences were found in the complication rate (OR: 1.58, 95% CI: 0.58 to 4.33, I2 = 0; p = 0.38) or in the incidence of hemodynamic crisis (OR: 0.74, 95% CI: 0.19 to 2.94, p = 0.67) between the two groups.ConclusionRetroperitoneal laparoscopic adrenalectomy could achieve better perioperative outcomes than the transperitoneal approach for patients with pheochromocytoma.
Highlights
To compare the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy with those of retroperitoneal laparoscopic adrenalectomy for patients with pheochromocytoma
Several studies have reported that no significant difference was found in operative time, estimated blood loss, or complication rates between the transperitoneal laparoscopic adrenalectomy (TLA) and posterior retroperitoneal laparoscopic adrenalectomy (PRA) approaches [5,6,7]
This study indicated that patients in the TLA group had significantly larger tumors than those in the PRA group (n = 145, weight mean difference (WMD): 139.32, 95% confidence interval (CI): 125.38 to 153.26, I2 = 0, p < 0.01)
Summary
To compare the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy with those of retroperitoneal laparoscopic adrenalectomy for patients with pheochromocytoma. Patients with PHEO usually present with symptoms attributable to hormonal secretion or an incidentally detected mass on imaging studies [1]. The widespread availability of ultrasound and computed tomography allows for increased incidental detection of PHEOs. Surgical resection is the treatment of choice for pheochromocytoma. Starting in the past decade, minimally invasive adrenalectomy is considered a gold standard for the treatment of adrenal tumors [4]. Several studies have reported that no significant difference was found in operative time, estimated blood loss, or complication rates between the transperitoneal laparoscopic adrenalectomy (TLA) and posterior retroperitoneal laparoscopic adrenalectomy (PRA) approaches [5,6,7].
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