The role of laparoscopic adrenalectomy in the treatment of large pheochromocytomas (>6cm): A meta-analysis and systematic review.

Abstract

The effectiveness and safety of laparoscopic adrenalectomy (LA) under different routes for the treatment of large pheochromocytomas (PCC) is unknown. This meta-analysis and systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Three databases were systematically searched, including Medline, PubMed, and Web of Science. The time frame of the search was set from the creation of the database to October 2022. Perioperative outcomes were divided into two groups according to tumor size: SMALL group (≤6cm in diameter), LARGE group (>6cm in diameter). Eight studies including 600 patients were included. In the LA group, complications was comparable in both groups (SMALL group and LARGE group), and the LARGE group had longer operative time [OT WMD=32.55, 95% CI (11.17, 53.92), P<0.01], length of stay [LOS WMD=0.82, 95% CI (0.19, 1.44), P<0.05], more estimated blood loss [EBL WMD=85.26, 95% CI (20.71, 149.82), P<0.05], hypertension [OR=3.99, 95% CI (1.84, 8.65), P<0.01], hypotension [OR=1.84, 95% CI (1.11, 3.05), P<0.05], and conversion [OR=5.60, 95% CI (1.56, 20.13), P<0.01]. In the transabdominal laparoscopic adrenalectomy (TLA) group, OT, LOS, EBL, complications, hypertension and hypotension were the same in both groups. In the retroperitoneal laparoscopic adrenalectomy (RLA) group, complications and hypotension were the same in both groups, while the LARGE group had longer OT [WMD=52.07, 95% CI (26.95, 77.20), P<0.01], LOS [WMD=0.51, 95% CI (0.00, 1.01), P<0.05], more EBL [WMD=92.99, 95% CI (27.70, 158.28), P<0.01] and higher rates of hypertension [OR=6.03, 95% CI (1.95, 18.61), P<0.01]. LA remains a safe and effective approach for large PCC. TLA is superior to RLA.