Transabdominal versus retroperitoneal laparoscopic adrenalectomy: A systematic review and meta-analysis.

Abstract

To compare the safety and effectiveness of transabdominal laparoscopic adrenalectomywith retroperitoneal laparoscopic adrenalectomy. We conducted a systematic review and meta-analysis of the main findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Assessing the Methodological Quality of Systematic Reviews Guidelines. Four databases were searched, including PubMed, Cochrane Library, Medline, and Scopus, and the time frame for the search was set from the creation of the databases to February 2025. There were 52 studies including 9,218 patients. The results showed that retroperitoneal laparoscopic adrenalectomy was superior to transabdominal laparoscopic adrenalectomy in terms of operative time (weighted mean difference, 8.58; 95% confidence interval, 1.49-15.66; P < .05), length of stay (weighted mean difference, 0.90, 95% confidence interval, 0.64-1.17), P < .01], estimated blood loss (weighted mean difference, 28.14; 95% confidence interval, 17.90-38.38, P < .01), food intake time (weighted mean difference, 0.31; 95% confidence interval, 0.24-0.37, P < .01), transfusion (odds ratio, 2.18; 95% confidence interval, 1.02-4.64, P < .05), total complications (odds ratio, 21.32; 95% confidence interval, 1.07-1.63; P < .01), and Clavien-Dindo grade >II complications (odds ratio, 21.87; 95% confidence interval, 1.17-3.00; P < .01). There was no statistically significant difference between the 2 surgical groups in terms of time to ambulation, conversion, and Clavien-Dindo grade I-II complications. For large adrenal tumors (>5 cm), retroperitoneal laparoscopic adrenalectomy was superior to transabdominal laparoscopic adrenalectomy in operative time (weighted mean difference, 21.40; 95% confidence interval, 1.20-41.60; P < .05), length of stay (weighted mean difference, 0.96; 95% confidence interval, 0.57-1.36, P < .01), estimated blood loss (weighted mean difference, 90.72; 95% confidence interval, 20.77-160.67; P < .05), food intake time (weighted mean difference, 0.68; 95% confidence interval, 0.16-1.20, P < .05), and total complications (odds ratio, 2.01; 95% confidence interval, 1.13-3.59; P < .05). The difference in conversion was not statistically significant. For pheochromocytomas, retroperitoneal laparoscopic adrenalectomy was superior to transabdominal laparoscopic adrenalectomy in operative time (weighted mean difference, 26.9; 95% confidence interval, 13.13-40.69; P < .01), length of stay (weighted mean difference, 1.38; 95% confidence interval, 0.82-1.94; P < .01), estimated blood loss (weighted mean difference, 125.46; 95% confidence interval, 54.18-196.74; P < .01), and food intake time (weighted mean difference, 0.84; 95% confidence interval, 0.42-1.27; P < .01). The differences in conversion, transfusion, total complications, and intraoperative hemodynamic instability were not statistically significant. For large pheochromocytomas (>5 cm), retroperitoneal laparoscopic adrenalectomy was superior to transabdominal laparoscopic adrenalectomy in terms of length of stay (weighted mean difference, 1.01, 95% confidence interval, 0.76-1.27; P < .01) and estimated blood loss (weighted mean difference, 177.42; 95% confidence interval, 17.65-337.20; P < .05). There was no statistically significant difference in terms of operative time, conversion, total complications, and intraoperative hemodynamic instability. In conclusion, this meta-analysis suggests that retroperitoneal laparoscopic adrenalectomy is a superior option to transabdominal laparoscopic adrenalectomy for the treatment of adrenal tumors and pheochromocytomas. For large adrenal tumors and pheochromocytoma (>5 cm), retroperitoneal laparoscopic adrenalectomy remains a preferable option, but for larger (>7 cm) and more complex adrenal tumors, transabdominal laparoscopic adrenalectomy should be given priority consideration. There is still a need for multicenter randomized controlled studies with larger sample sizes to support this conclusion.