Laparoscopic adrenalectomy (LA) vs open adrenalectomy (OA) for pheochromocytoma (PHEO): A systematic review and meta-analysis.

PURPOSE: To evaluate the efficacy and safety of laparoscopic adrenalectomy (LA) vs open adrenalectomy (OA) for pheochromocytoma (PHEO).

METHODS

A systematic literature research of PubMed, Ovid, Scopus, and citation lists were performed to identify eligible studies. All studies comparing LA versus OA for PHEO were included.

RESULTS

Overall, fourteen studies including 743 patients (LA 391; OA 352) were included. LA might have smaller tumor size (WMD -0.92 cm, 95% CI -1.09 to -0.76; p < 0.001) and higher body mass index (BMI) (WMD 0.31 kg/m2, 95% CI 0.04 to 0.58; p = 0.02). Compared to OA, LA showed lower estimated blood loss (EBL) (WMD -207.72 ml, 95% CI -311.26, -104.19; p < 0.001), lower transfusion rate (OR 0.25, 95% CI 0.16 to 0.38; p < 0.001), lower hemodynamic instability (HI) (OR 0.61, 95% CI 0.42 to 0.88; p = 0.009), less postoperative complications (OR 0.55, 95% CI 0.34 to 0.89; p = 0.02), less Clavien Dindo score ≥3 complications (OR 0.51, 95% CI 0.27 to 0.97; p = 0.04), shorter return to diet time (WMD -0.76 days, 95% CI -1.27 to -0.25; p = 0.003), and shorter length of hospital stay (WMD -1.76 days, 95% CI -2.94 to -0.58; p < 0.001). The subgroup analysis of studies since 2008 showed consistent results.

CONCLUSION

LA shows a feasible, safe and superior treatment option for PHEO, because it provides superior perioperative and recovery outcomes without increasing complications.