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. 2022 Feb;407(1):285-296.
doi: 10.1007/s00423-022-02431-w. Epub 2022 Jan 12.

Minimally invasive adrenalectomy: a comprehensive systematic review and network meta-analysis of phase II/III randomized clinical controlled trials

Laura Alberici  1 , Carlo Ingaldi  1   2 , Claudio Ricci  3   4   5 , Saverio Selva  1 , Guido Di Dalmazi  2   6 , Valentina Vicennati  2   6 , Uberto Pagotto  2   6 , Riccardo Casadei  1   2 , Francesco Minni  1   2
Affiliations

Minimally invasive adrenalectomy: a comprehensive systematic review and network meta-analysis of phase II/III randomized clinical controlled trials

Laura Alberici et al. Langenbecks Arch Surg. 2022 Feb.

Abstract

Purpose: The best approach for minimally invasive adrenalectomy is still under debate.

Methods: A systematic search of randomized clinical trials was carried out. A frequentist random-effects network meta-analysis was made reporting the surface under the cumulative ranking (SUCRA). The primary endpoint regarded both in-hospital mortality and morbidity. The secondary endpoints were operative time (OP), blood loss (BL), length of stay (LOS), conversion, incisional hernia, and disease recurrence rate.

Results: Eight studies were included, involving 359 patients clustered as follows: 175 (48.7%) in the TPLA arm; 55 (15.3%) in the RPLA arm; 10 (2.8%) in the Ro-TPLA arm; 25 (7%) in the TPAA arm; 20 (5.6%) in the SILS-LA arm; and 74 (20.6%) in the RPA arm. The RPLA had the highest probability of being the safest approach (SUCRA 69.6%), followed by RPA (SUCRA 63.0%). TPAA, Ro-TPLA, SILS-LA, and TPLA have similar probability of being safe (SUCRA values 45.2%, 43.4%, 43.0%, and 38.5%, respectively). Analysis of the secondary endpoints confirmed the superiority of RPA regarding OP, BL, LOS, and incisional hernia rate.

Conclusions: The best choice for patients with adrenal masses candidate for minimally invasive surgery seems to be RPA. An alternative could be RPLA. The remaining approaches could have some specific advantages but do not represent the first minimally invasive choice.

Keywords: Efficacy; Laparoscopic adrenalectomy; Network meta-analysis; Retroperitoneal adrenalectomy; Safety.

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Conflict of interest statement

All authors disclose financial and non-financial interests that are directly or indirectly related to the work submitted for publication. Finally, all authors disclose any conflict of interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Fig. 2
Fig. 2
Network geometry for the primary endpoint (mortality or major complications). The network geometry graphically describes the direct comparisons available in the literature. In the figure, the blue nodes represent the interventions compared, while the edges represent the direct comparisons available (comparisons evaluated in at least one study) between pairs of interventions. TPLA = Transperitoneal laparoscopic lateral adrenalectomy; RPLA = retroperitoneal mini-invasive lateral adrenalectomy; Ro-TPLA = transperitoneal laparoscopic lateral adrenalectomy with robotic approach; TPAA = transperitoneal laparoscopic anterior adrenalectomy (TPAA); SILS-LA = single-incision laparoscopic adrenalectomy; RPA = retroperitoneal mini-invasive posterior adrenalectomy
Fig. 3
Fig. 3
Safety/efficacy combination of all the approaches available for treating adrenal neoplasms. In the figure, the primary endpoint (safety indicator) is combined with a secondary endpoint (surrogate parameter of efficacy). Cluster rank combined the surface under the cumulative ranking curve (SUCRA) values of the composite endpoint and length of stay. On the y-axis, the SUCRA values correspond to the probability in percentages that each approach was the safest. On the x-axis, the SUCRA values correspond to the probability in percentages that each approach was most efficacious. Different colors identify the different clusters. TPLA = Transperitoneal laparoscopic lateral adrenalectomy; RPLA = retroperitoneal mini-invasive lateral adrenalectomy; Ro-TPLA = transperitoneal laparoscopic lateral adrenalectomy with robotic approach; TPAA = transperitoneal laparoscopic anterior adrenalectomy; SILS-LA = single-incision laparoscopic adrenalectomy; RPA = retroperitoneal mini-invasive posterior adrenalectomy
See this image and copyright information in PMC

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