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Meta-Analysis
. 2023 May 1;109(5):1459-1469.
doi: 10.1097/JS9.0000000000000389.

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

Lijian Gan  1 , Lei Peng  2 , Chunyang Meng  1 , Lei Zheng  1 , Zhiqiang Zeng  3   4 , Si Ge  3   4 , Zuoping Wang  1 , Kangsen Li  1 , Yunxiang Li  1
Affiliations
Meta-Analysis

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

Lijian Gan et al. Int J Surg. .

Abstract

Background: The effectiveness and safety of laparoscopic adrenalectomy (LA) under different routes for the treatment of large pheochromocytomas (PCCs) is unknown.

Materials and methods: 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 (≤6 cm in diameter), LARGE group (>6 cm in diameter).

Results: 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 weighted mean difference (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 [odds ratio (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 LA group, OT, LOS, EBL, complications, hypertension, and hypotension were the same in both groups. In the retroperitoneal LA 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).

Conclusions: LA remains a safe and effective approach for large PCC. Transabdominal LA is superior to retroperitoneal LA.

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Conflict of interest statement

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process.
Figure 2
Figure 2
Forest plot and meta-analysis of the age between LARGE and SMALL groups.
Figure 3
Figure 3
Forest plot and meta-analysis of the BMI between LARGE and SMALL groups.
Figure 4
Figure 4
Forest plot and meta-analysis of the sex between LARGE and SMALL groups. RLA, retroperitoneal laparoscopic adrenalectomy; TLA, transperitoneal laparoscopic adrenalectomy.
Figure 5
Figure 5
Forest plot and meta-analysis of the tumor laterality between LARGE and SMALL groups. RLA, retroperitoneal laparoscopic adrenalectomy; TLA, transperitoneal laparoscopic adrenalectomy.
Figure 6
Figure 6
Forest plot and meta-analysis of the tumor size between LARGE and SMALL groups. RLA, retroperitoneal laparoscopic adrenalectomy; TLA, transperitoneal laparoscopic adrenalectomy.
Figure 7
Figure 7
Forest plot and meta-analysis of the operative time between LARGE and SMALL groups. RLA, retroperitoneal laparoscopic adrenalectomy; TLA, transperitoneal laparoscopic adrenalectomy.
Figure 8
Figure 8
Forest plot and meta-analysis of the length of stay between LARGE and SMALL groups. RLA, retroperitoneal laparoscopic adrenalectomy; TLA, transperitoneal laparoscopic adrenalectomy.
Figure 9
Figure 9
Forest plot and meta-analysis of the estimated blood loss between LARGE and SMALL groups. RLA, retroperitoneal laparoscopic adrenalectomy; TLA, transperitoneal laparoscopic adrenalectomy.
Figure 10
Figure 10
Forest plot and meta-analysis of the complications between LARGE and SMALL groups. RLA, retroperitoneal laparoscopic adrenalectomy; TLA, transperitoneal laparoscopic adrenalectomy.
Figure 11
Figure 11
Forest plot and meta-analysis of hypertension between LARGE and SMALL groups. RLA, retroperitoneal laparoscopic adrenalectomy; TLA, transperitoneal laparoscopic adrenalectomy.
Figure 12
Figure 12
Forest plot and meta-analysis of the hypotension between LARGE and SMALL groups. RLA, retroperitoneal laparoscopic adrenalectomy; TLA, transperitoneal laparoscopic adrenalectomy.
Figure 13
Figure 13
A: Forest plot and meta-analysis of the conversion between LARGE and SMALL groups.
See this image and copyright information in PMC

References

    1. Opocher G, Schiavi F, Conton P, et al. Clinical and genetic aspects of phaeochromocytoma. Horm Res 2003;59(suppl 1):56–61. - PubMed
    1. Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet 2005;366:665–675. - PubMed
    1. Bravo EL, Gifford RW, Jr. Pheochromocytoma. Endocrinol Metab Clin North Am 1993;22:329–341. - PubMed
    1. Lenders JWM, Kerstens MN, Amar L, et al. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens 2020;38:1443–1456. - PMC - PubMed
    1. Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 1992;327:1033. - PubMed