Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China.
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
Int J Surg. 2022 Aug;104:106779. doi: 10.1016/j.ijsu.2022.106779. Epub 2022 Jul 20.
This systematic review and meta-analysis compared the safety and effectiveness of minimally invasive adrenalectomy (MIA) with open adrenalectomy (OA) in patients with large adrenal tumors (≥5 cm).
We performed a systematic review and cumulative meta-analysis of the primary outcomes according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Five databases including Medline, PubMed, Cochrane Library, Scopus, and Web of Science were systematically searched. The time frame of the search was set from the creation of the database to March 2022.
Ten studies including 898 patients were included. Compared to OA, MIA is superior for length of stay [LOS WMD = -3.52, 95% CI (-4.61, -2.43), P < 0.01], drainage time [DT WMD = -0.68, 95% CI (-1.27, -0.09), P < 0.05] and fasting time [FT WMD = -0.95, 95% CI (-1.35, -0.55), P < 0.01], estimated blood loss [EBL WMD = -314.22, 95% CI (-494.76, -133.69), P < 0.01] and transfusion [WMD = -416.73, 95% CI (-703.75, -129.72), P < 0.01], while operative time (OT) and complications are not statistically different. For pheochromocytoma, MIA remains superior for LOS [WMD = -3.10, 95% CI (-4.61, -1.60), P < 0.01] and EBL [WMD = -273.65, 95% CI (-457.44, -89.86), P < 0.01], while OT and complications are not significantly different.
MIA offers advantages over OA in the management of large adrenal tumors, including in the case of a specific large adrenal tumor - large pheochromocytoma.
本系统评价和荟萃分析比较了微创肾上腺切除术（MIA）与开放肾上腺切除术（OA）治疗大肾上腺肿瘤（≥5cm）的安全性和有效性。
我们根据 PRISMA（系统评价和荟萃分析的首选报告项目）和 AMSTAR（系统评价方法质量评估）指南进行了系统评价和累积荟萃分析。系统检索了 Medline、PubMed、Cochrane 图书馆、Scopus 和 Web of Science 五个数据库。检索时间设定为数据库创建至 2022 年 3 月。
纳入 10 项研究共 898 例患者。与 OA 相比，MIA 在住院时间[WMD=-3.52，95%CI（-4.61，-2.43），P<0.01]、引流时间[WMD=-0.68，95%CI（-1.27，-0.09），P<0.05]和禁食时间[WMD=-0.95，95%CI（-1.35，-0.55），P<0.01]、估计失血量[WMD=-314.22，95%CI（-494.76，-133.69），P<0.01]和输血[WMD=-416.73，95%CI（-703.75，-129.72），P<0.01]方面更有优势，而手术时间（OT）和并发症无统计学差异。对于嗜铬细胞瘤，MIA 仍在住院时间[WMD=-3.10，95%CI（-4.61，-1.60），P<0.01]和估计失血量[WMD=-273.65，95%CI（-457.44，-89.86），P<0.01]方面具有优势，而 OT 和并发症无显著差异。
MIA 在治疗大肾上腺肿瘤方面优于 OA，包括治疗特定的大肾上腺肿瘤-大嗜铬细胞瘤。
