Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University).
Department of Urology, The Second Hospital of Lanzhou University Medical School, Lanzhou, Gansu Province, China.
Int J Surg. 2023 May 1;109(5):1459-1469. doi: 10.1097/JS9.0000000000000389.
The effectiveness and safety of laparoscopic adrenalectomy (LA) under different routes for the treatment of large pheochromocytomas (PCCs) is unknown.
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).
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).
LA remains a safe and effective approach for large PCC. Transabdominal LA is superior to retroperitoneal LA.
腹腔镜肾上腺切除术（LA）治疗大嗜铬细胞瘤（PCC）的有效性和安全性尚不清楚。
本荟萃分析和系统评价根据 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。系统检索了 Medline、PubMed 和 Web of Science 三个数据库，检索时间从数据库创建到 2022 年 10 月。根据肿瘤大小将围手术期结果分为两组：SMALL 组（直径≤6cm），LARGE 组（直径>6cm）。
共纳入 8 项研究 600 例患者。在 LA 组中，两组的并发症相似，LARGE 组的手术时间更长[OT 加权均数差（WMD）=32.55；95%置信区间：11.17，53.92；P<0.01]，住院时间更长[LOS WMD=0.82；95%置信区间：0.19，1.44；P<0.05]，估计出血量更多[EBL WMD=85.26；95%置信区间：20.71，149.82；P<0.05]，高血压[比值比（OR）=3.99；95%置信区间：1.84，8.65；P<0.01]，低血压（OR=1.84；95%置信区间：1.11，3.05；P<0.05）和中转（OR=5.60；95%置信区间：1.56，20.13；P<0.01）的发生率更高。在经腹 LA 组中，OT、LOS、EBL、并发症、高血压和低血压在两组间相同。在经腹膜后 LA 组中，两组的并发症和低血压相同，而 LARGE 组的 OT 更长[WMD=52.07；95%置信区间：26.95，77.20；P<0.01]，LOS 更长[WMD=0.51；95%置信区间：0.00，1.01；P<0.05]，EBL 更多[WMD=92.99；95%置信区间：27.70，158.28；P<0.01]，高血压的发生率更高[OR=6.03；95%置信区间：1.95，18.61；P<0.01]。
LA 仍然是治疗大 PCC 的安全有效的方法。经腹 LA 优于经腹膜后 LA。
