腹腔镜肾上腺切除术（LA）与开放肾上腺切除术（OA）治疗嗜铬细胞瘤（PHEO）：系统评价和荟萃分析。

Laparoscopic adrenalectomy (LA) vs open adrenalectomy (OA) for pheochromocytoma (PHEO): A systematic review and meta-analysis.

机构信息

Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.

出版信息

Eur J Surg Oncol. 2020 Jun;46(6):991-998. doi: 10.1016/j.ejso.2020.02.009. Epub 2020 Feb 17.

DOI:10.1016/j.ejso.2020.02.009

PMID:32102743

Abstract

PURPOSE

To evaluate the efficacy and safety of laparoscopic adrenalectomy (LA) vs open adrenalectomy (OA) for pheochromocytoma (PHEO).

METHODS

A systematic literature research of PubMed, Ovid, Scopus, and citation lists were performed to identify eligible studies. All studies comparing LA versus OA for PHEO were included.

RESULTS

Overall, fourteen studies including 743 patients (LA 391; OA 352) were included. LA might have smaller tumor size (WMD -0.92 cm, 95% CI -1.09 to -0.76; p < 0.001) and higher body mass index (BMI) (WMD 0.31 kg/m, 95% CI 0.04 to 0.58; p = 0.02). Compared to OA, LA showed lower estimated blood loss (EBL) (WMD -207.72 ml, 95% CI -311.26, -104.19; p < 0.001), lower transfusion rate (OR 0.25, 95% CI 0.16 to 0.38; p < 0.001), lower hemodynamic instability (HI) (OR 0.61, 95% CI 0.42 to 0.88; p = 0.009), less postoperative complications (OR 0.55, 95% CI 0.34 to 0.89; p = 0.02), less Clavien Dindo score ≥3 complications (OR 0.51, 95% CI 0.27 to 0.97; p = 0.04), shorter return to diet time (WMD -0.76 days, 95% CI -1.27 to -0.25; p = 0.003), and shorter length of hospital stay (WMD -1.76 days, 95% CI -2.94 to -0.58; p < 0.001). The subgroup analysis of studies since 2008 showed consistent results.

CONCLUSION

LA shows a feasible, safe and superior treatment option for PHEO, because it provides superior perioperative and recovery outcomes without increasing complications.

摘要

目的

评估腹腔镜肾上腺切除术（LA）与开放肾上腺切除术（OA）治疗嗜铬细胞瘤（PHEO）的疗效和安全性。

方法

对 PubMed、Ovid、Scopus 和参考文献列表进行系统文献检索，以确定合格的研究。所有比较 LA 与 OA 治疗 PHEO 的研究均被纳入。

结果

共纳入 14 项研究，包括 743 例患者（LA 组 391 例，OA 组 352 例）。LA 可能具有更小的肿瘤大小（WMD-0.92cm，95%CI-1.09 至-0.76；p<0.001）和更高的体重指数（BMI）（WMD0.31kg/m，95%CI0.04 至 0.58；p=0.02）。与 OA 相比，LA 显示出更低的估计失血量（EBL）（WMD-207.72ml，95%CI-311.26，-104.19；p<0.001）、更低的输血率（OR0.25，95%CI0.16 至 0.38；p<0.001）、更低的血流动力学不稳定性（HI）（OR0.61，95%CI0.42 至 0.88；p=0.009）、更少的术后并发症（OR0.55，95%CI0.34 至 0.89；p=0.02）、更少的 Clavien Dindo 评分≥3 级并发症（OR0.51，95%CI0.27 至 0.97；p=0.04）、更短的恢复饮食时间（WMD-0.76 天，95%CI-1.27 至-0.25；p=0.003）和更短的住院时间（WMD-1.76 天，95%CI-2.94 至-0.58；p<0.001）。自 2008 年以来的研究亚组分析显示出一致的结果。