Danwang Celestin, Agbor Valirie Ndip, Bigna Jean Joel
Epidemiology and Biostatistics Unit, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium.
Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
BMC Surg. 2020 Aug 31;20(1):194. doi: 10.1186/s12893-020-00848-y.
Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be ascertained with synthesis of available evidence. The aim of this systematic review and meta-analysis was to investigate the association between obesity and outcomes of patients after laparoscopic adrenalectomy.
We searched EMBASE, PubMed, Global Index Medicus, and Web of Science, without language restriction, to identify cohort studies published between January 1, 2000 and November 6, 2019. We considered studies with data comparing outcomes of adults with and without obesity after laparoscopic adrenalectomy. Random-effects meta-analysis was used to pool study-specific estimates. This review was registered with PROSPERO, CRD42018117070.
Five studies with data on a pooled sample of 353 patients with obesity and 828 without were included in the meta-analysis. The risk of bias was moderate to low. We found no association between obesity and the various stages of postoperative complications: Clavien-Dindo grade 1 (OR = 1.57; 95%CI = 0.55-4.48; I = 44.6%), grade 2 (OR = 1.12; 95%CI = 0.54-2.32; I = 0.0%), grade 3 (OR = 1.79; 95%CI = 0.58-5.47; I = 0.0%;), grade 4 (OR = 0.43; 95%CI = 0.05-3.71; I = 0.0%), and grade 5 (death) (OR = 0.43; 95% CI = 0.02-14.31). Furthermore, no association was found between obesity and readmission rates (OR = 0.7; 95% CI = 0.13-3.62) and conversion of laparoscopic to open surgery (OR = 0.62; 95% CI = 0.16-2.34; I = 19.5%).
This study suggests that obesity is not associated with complications following laparoscopic adrenalectomy. This meta-analysis might have been underpowered to detect a true association between obesity and patient outcome after laparoscopic adrenalectomy due to the small number of included studies. Larger studies are needed to clarify the role of obesity in patients undergoing laparoscopic adrenalectomy.
研究表明，肥胖患者与非肥胖患者肾上腺切除术后的预后存在差异，但这些差异仍有待综合现有证据加以确定。本系统评价和荟萃分析的目的是研究肥胖与腹腔镜肾上腺切除术后患者预后之间的关联。
我们检索了EMBASE、PubMed、全球医学索引和科学网，无语言限制，以识别2000年1月1日至2019年11月6日发表的队列研究。我们纳入了比较腹腔镜肾上腺切除术后肥胖和非肥胖成年人预后数据的研究。采用随机效应荟萃分析汇总各研究的估计值。本评价已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42018117070。
五项研究纳入了荟萃分析，这些研究的数据来自353例肥胖患者和828例非肥胖患者的合并样本。偏倚风险为中度至低度。我们发现肥胖与术后并发症的各个阶段之间无关联：Clavien-Dindo 1级（比值比[OR]=1.57；95%置信区间[CI]=0.55-4.48；I²=44.6%）、2级（OR=1.12；95%CI=0.54-2.32；I²=0.0%）、3级（OR=1.79；95%CI=0.58-5.47；I²=0.0%）、4级（OR=0.43；95%CI=0.05-3.71；I²=0.0%）和5级（死亡）（OR=0.43；95%CI=0.02-14.31）。此外，未发现肥胖与再入院率（OR=0.7；95%CI=0.13-3.62）及腹腔镜手术转为开放手术（OR=0.62；95%CI=0.16-2.34；I²=19.5%）之间存在关联。
本研究表明，肥胖与腹腔镜肾上腺切除术后的并发症无关。由于纳入研究数量较少，本荟萃分析可能不足以检测出肥胖与腹腔镜肾上腺切除术后患者预后之间的真正关联。需要开展更大规模的研究以阐明肥胖在接受腹腔镜肾上腺切除术患者中的作用。
