Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Chin Clin Oncol. 2024 Oct;13(5):67. doi: 10.21037/cco-24-55.
Transperitoneal laparoscopic adrenalectomy (TLA) is the most frequently chosen approach in adrenal surgery. At present, impact of obesity on patient outcomes following adrenal surgery is frequently under discussion. We intended to offer updated evidence thanks to a comparison between intraoperative and perioperative outcomes in non-obese and obese patients, who underwent TLA for benign or malignant adrenal diseases.
Our systematic review made use of Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Articles of interest turned out from a search with PubMed/MEDLINE, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials-CENTRAL), Web of Science (Science and Social Science Citation Index), and Scopus databases. We evaluated two groups of outcomes: intraoperative (operative time, intraoperative complications rate, estimated blood loss (EBL), transfusion rate, conversion to open surgery rate) and postoperative (overall postoperative complications rate, major postoperative complications rate, length of hospital stay). RevMan (Computer program) Version 5.4 was used to perform the meta-analysis. The heterogeneity of the included studies in the meta-analysis was assessed by using the I2 statist.
The 8 included comparative studies (1,646 patients: 995 non-obese versus 651 obese) had a time frame of approximately 30 years (1994-2020) and an observational nature. Meta-analysis showed no differences in terms of operative time, intraoperative complications rate, EBL, transfusion rate, conversion to open surgery rate, overall postoperative complications rate, major (Clavien-Dindo ≥ III) postoperative complications rate, length of hospital stay between non-obese and obese populations.
We can say that obesity does not impact TLA safety and effectiveness. Due to biases among meta-analyzed studies (small overall sample size and small number of events analyzed, in particular), careful interpretation is needed to interpret our results. Additional randomized, possibly multi-center trials may contribute to confirm our results.
经腹腔腹腔镜肾上腺切除术（TLA）是肾上腺手术中最常选择的方法。目前，肥胖对肾上腺手术后患者结局的影响经常被讨论。我们旨在通过比较非肥胖和肥胖患者的术中及围手术期结果，为这一问题提供最新的证据，这些患者因良性或恶性肾上腺疾病接受了 TLA 治疗。
我们的系统评价使用了系统评价和荟萃分析的首选报告项目（PRISMA）指南。从 PubMed/MEDLINE、Cochrane 图书馆（Cochrane 系统评价数据库、Cochrane 中心对照试验注册库-CENTRAL）、Web of Science（科学和社会科学引文索引）和 Scopus 数据库进行搜索后获得了感兴趣的文章。我们评估了两组结果：术中（手术时间、术中并发症发生率、估计失血量（EBL）、输血率、转为开放手术率）和术后（总术后并发症发生率、主要术后并发症发生率、住院时间）。RevMan（计算机程序）版本 5.4 用于进行荟萃分析。使用 I2 统计量评估纳入荟萃分析的研究的异质性。
8 项纳入的比较研究（1646 例患者：995 例非肥胖与 651 例肥胖）的时间框架约为 30 年（1994-2020 年），且为观察性研究。荟萃分析显示，在手术时间、术中并发症发生率、EBL、输血率、转为开放手术率、总术后并发症发生率、主要（Clavien-Dindo ≥ III）术后并发症发生率和住院时间方面，非肥胖和肥胖人群之间没有差异。
我们可以说肥胖并不影响 TLA 的安全性和有效性。由于荟萃分析研究中存在偏倚（总体样本量小，分析的事件数量少），需要谨慎解释我们的结果。可能有助于确认我们结果的额外随机、可能多中心试验可能会有所帮助。
