Alzelfawi Lama, Almajed Ebtesam, Alhindawi Zeena, AlDosari Lena, Alhumaidan Almaha, Alharthi Bandar
College of Medicine, Princess Noura Bint Abdulrahman University, Riyadh, Saudi Arabia.
College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
Gland Surg. 2024 Jun 30;13(6):952-968. doi: 10.21037/gs-24-69. Epub 2024 Jun 27.
Laparoscopic adrenalectomy (LA) has emerged as the primary treatment for adrenal masses. This systematic review and meta-analysis assessed LA's feasibility, safety, effectiveness, and complications for adrenal masses exceeding 5 cm.
The study was conducted using PRISMA guidelines with PROSPERO registration No. CRD42023462901. Adults with unilateral adrenal masses >5 cm who underwent unilateral LA were included. Intraoperative and postoperative measurements and complications were assessed. A systematic literature review employed a comprehensive search strategy which was last searched on September 8, 2023, through PubMed, Google Scholar, Web of Science, and ProQuest databases. Meta-analysis was utilized to analyze the outcomes. Risk of bias was assessed using the Newcastle-Ottawa scale.
This systematic review encompassed 25 studies involving 963 patients who underwent LA. Tumor size varied 7.05 cm [95% confidence interval (CI): 6.24-7.70], with 50% on the right and 45% on the left. The subgroup meta-analysis comparing the transperitoneal and retroperitoneal approaches revealed the transperitoneal approach h was utilized for the largest tumor size with a mean of 12.10 cm (95% CI: 11.30-12.96), compared to the retroperitoneal approach 5.83 cm (95% CI: 5.52-6.14). Notably, the mean operative time across studies was 137.4 minutes (95% CI: 113.36-150.94), bleeding prevalence was 0.02% (95% CI: 0.01-0.03%), and average blood loss was 110.6 mL (95% CI: 78.2-156.3). Postoperative complications such as pulmonary edema, pulmonary embolism, gastric dysfunction, and wound infection were very low, ranging from 0.03% to 0.4%. Out of 963 patients, only 49 were converted to open surgery. Patient hospital stay averaged 3.72 days (95% CI: 2.97-4.66); blood transfusion was required in 1.3% (95% CI: 0.30-8.88%).
The feasibility and safety of LA for tumors exceeding 5 cm in size have notable implications for intraoperative and postoperative outcomes. Underreporting in the included studies may impact the generalizability of findings.
腹腔镜肾上腺切除术（LA）已成为肾上腺肿块的主要治疗方法。本系统评价和荟萃分析评估了LA治疗直径超过5 cm的肾上腺肿块的可行性、安全性、有效性及并发症。
本研究采用PRISMA指南进行，PROSPERO注册号为CRD42023462901。纳入接受单侧LA的单侧肾上腺肿块>5 cm的成年人。评估术中及术后测量指标和并发症。系统文献回顾采用全面检索策略，最后一次检索时间为2023年9月8日，通过PubMed、谷歌学术、科学网和ProQuest数据库进行。采用荟萃分析来分析结果。使用纽卡斯尔-渥太华量表评估偏倚风险。
本系统评价纳入了25项研究，涉及963例行LA的患者。肿瘤大小平均为7.05 cm [95%置信区间（CI）：6.24 - 7.70]，右侧占50%，左侧占45%。比较经腹和经后腹腔途径的亚组荟萃分析显示，经腹途径用于最大肿瘤大小，平均为12.10 cm（95% CI：11.30 - 12.96），而经后腹腔途径为5.83 cm（95% CI：5.52 - 6.14）。值得注意的是，各研究的平均手术时间为137.4分钟（95% CI：113.36 - 150.94），出血发生率为0.02%（95% CI：0.01 - 0.03%），平均失血量为110.6 mL（95% CI：78.2 - 156.3）。肺水肿、肺栓塞、胃功能障碍和伤口感染等术后并发症非常低，范围为0.03%至0.4%。在963例患者中，仅49例转为开放手术。患者平均住院时间为3.72天（95% CI：2.97 - 4.66）；1.3%（95% CI：0.30 - 8.88%）的患者需要输血。
LA治疗直径超过5 cm肿瘤的可行性和安全性对术中和术后结果有显著影响。纳入研究中的报告不足可能会影响研究结果的普遍性。
