Retroperitoneal Versus Transperitoneal Laparoscopic Adrenalectomy in Adrenal Tumor: A Meta-Analysis

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Background:The study aims to provide a pooled meta-analysis of existing studies that compare the outcomes of retroperitoneal laparoscopic adrenalectomy with transperitoneal approach for adrenal tumor.Methods:A systematic search of electronic databases was performed and studies were selected based on specific inclusion and exclusion criteria. Data of interest were subjected to meta-analysis using randomized or fixed-effect model to calculate weight mean difference (WMD) or odds ratio (OR). The sensitivity analysis and publication bias test also be conducted.Results:Nine observational studies with 632 patients were identified (339 retroperitoneal vs. 293 transperitoneal). Retroperitoneal approach was associated with shorter operative time [WMD=−13.10; 95% confidence interval (CI), −23.83 to −2.36; P=0.02], less intraoperative blood loss (WMD=−40.60; 95% CI, −79.73 to −1.47; P=0.04), shorter duration of hospital stay (WMD=−1.25; 95% CI, −2.36 to −0.14; P=0.03), or time to first ambulation (WMD=−0.38; 95% CI, −0.47 to −0.28; P<0.001). Although the difference between number of convert to open management, time to first oral intake, and major postoperative complication rate was not significant (OR=0.53; 95% CI, 0.17 to 1.60; P=0.26; WMD=−0.31; 95% CI, −1.14 to 0.52; P=0.47; OR=0.41; 95% CI, 0.06 to 1.06; P=0.07).Conclusions:The present evidence demonstrates that retroperitoneal adrenalectomy is better than transperitoneal approach for patients with adrenal tumor in short-term outcomes. However, extended follow-ups and further randomized controlled trials should be required to analysis.

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