Elsevier

Surgery

Volume 153, Issue 1, January 2013, Pages 111-119
Surgery

Original Communication
Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy

https://doi.org/10.1016/j.surg.2012.05.042Get rights and content

Background

Laparoscopic adrenalectomies are being performed increasingly, either with transperitoneal or retroperitoneal approaches. Studies comparing the 2 approaches have not shown the superiority of either technique, but these studies are limited by small sample sizes and single-institution designs. To overcome these limitations, we performed a meta-analysis of studies comparing lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy.

Methods

A systematic review of studies comparing lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy was conducted. Study endpoints included perioperative outcomes and measures of postoperative recovery. Meta-analysis was performed using a random effects model, pooling variables evaluated by more than 3 studies.

Results

Twenty-one studies comparing a total of 1,205 lateral transperitoneal adrenalectomies and 688 retroperitoneal adrenalectomies were suitable for meta-analysis. Patients in the 2 groups were similar in term of age, sex, body mass index, lesion size and location, and rates of malignancy. There were no statistically significant differences between lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy in terms of operative time, blood loss, hospital stay, time to oral intake, overall and major morbidity, and mortality.

Conclusion

Both lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy are associated with very low rates of perioperative complications. According to our meta-analysis, clinical outcomes after either technique are similar. For most adrenal lesions requiring operation, minimally invasive adrenalectomy can be performed safely and effectively with either transperitoneal or the retroperitoneal approach. Additional studies may be needed to analyze if any difference in long-term results exist.

Section snippets

Study selection

A systematic literature search was performed using Embase, Medline, Cochrane, and PubMed databases to identify all studies published up to and including January 2012 that compared LTPA with LRPA. The following MESH search headings were used: “laparoscopic adrenalectomy,” “minimally invasive adrenalectomy,” “retroperitoneoscopic adrenalectomy,” and “retroperitoneal adrenalectomy.” The “related articles” function was used to broaden the search, and all abstracts, studies, and citations scanned

Search results

Twenty-one studies comparing LTPA and LRPA published between 1996 and 201117, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 met the inclusion criteria and were suitable for meta-analysis. The reports primarily described retrospective studies of comparable patients; 2 studies were randomized prospective trials.25, 37 The 2 reviewers had 100% agreement in their reviews of the data extraction. The characteristics of the included studies are shown in Table I.

Patient characteristics and indications for operation

Discussion

Since its first description in 1992 by Gagner et al,1, 38 minimally invasive adrenalectomy has become the preferred technique for the removal of benign functioning and nonfunctioning adrenal tumors. Retrospective studies and case series have shown the benefits of minimally invasive techniques in adrenalectomy. When compared to open surgery, minimally invasive adrenal surgery has resulted in shorter hospital stays and recovery time, decreased requirements for analgesics, and improved patient

References (55)

  • M. Takeda et al.

    Retroperitoneal laparoscopic adrenalectomy for functioning adrenal tumors: comparison with conventional transperitoneal laparoscopic adrenalectomy

    J Urol

    (1997)
  • T. Imai et al.

    A case-controlled study of laparoscopic compared with open lateral adrenalectomy

    Am J Surg

    (1999)
  • G.B. Thompson et al.

    Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients

    Surgery

    (1997)
  • B. Lang et al.

    Retrospective comparison of retroperitoneoscopic versus open adrenalectomy for pheochromocytoma

    J Urol

    (2008)
  • J. Lee et al.

    Open and laparoscopic adrenalectomy: analysis of the National Surgical Quality Improvement Program

    J Am Coll Surg

    (2008)
  • O.A. Castillo et al.

    Laparoscopic adrenalectomy for adrenal masses: does size matter?

    Urology

    (2008)
  • D. Brix et al.

    Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients

    Eur Urol

    (2010)
  • M. Gagner et al.

    Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma

    N Engl J Med

    (1992)
  • A. Assalia et al.

    Laparoscopic adrenalectomy

    Br J Surg

    (2004)
  • J.K. Jacobs et al.

    Laparoscopic adrenalectomy: a new standard of care

    Ann Surg

    (1997)
  • A.D. Linos et al.

    Anterior, posterior, or laparoscopic approach for the management of adrenal diseases?

    Am J Surg

    (1997)
  • E. Lezoche et al.

    Flank approach versus anterior sub-mesocolic access in left laparoscopic adrenalectomy: a prospective randomized study

    Surg Endosc

    (2008)
  • N.D. Perrier et al.

    Posterior retroperitoneoscopic adrenalectomy: preferred technique for removal of benign tumors and isolated metastases

    Ann Surg

    (2008)
  • A.S. Midgette et al.

    A metaanalytic method for summarizing diagnostic test performances: receiver-operating-characteristic-summary point estimates

    Med Decis Making

    (1993)
  • J.L. Fleiss

    Statistical methods for rates and proportions

    (1981)
  • J.A. Hanley et al.

    If nothing goes wrong, is everything all right? Interpreting zero numerators

    JAMA

    (1983)
  • D.B. Petitti

    Metaanalysis, decision analysis, and costeffectiveness analysis: methods for quantitative synthesis in medicine

    (1994)

    • Cited by (0)

    View full text
    Copyright © 2013 Mosby, Inc. All rights reserved.