Efficacy And Safety Of Retroperitoneoscopic Adrenalectomy: A Meta-analysis

Objective:To evaluate the efficacy and safety of retroperitoneoscopic vs laparoscopic and Open Adrenalectomy.Methods:Aticles including randomized controlled trials (RCT), non-randomized controlled trials (NRCT) of both Chinese and English studies around the world about retroperitoneoscopic versus laparoscopic adrenalectomy(or open adrenalectomy) were searched by Pubmed, Ovid, ScineceDirect, NGC, EBSCO, EMBASE, CNKI, CBM,as well as manual search of four Chinese journals:Chinese of Journal of Androloy, National Journal of Androlgy, Chinese Journal of Urology, Journal of Clinical Urology. Two reviewers independently screened the studies for eligibility,evaluated the quality and extracted the data from the eligible studies,with confirmation by cross-checking.Divergences of opinion were settled by discussion or consulted by the experts. Data extracted from the eligible studies,Meta-analysis and sensitivity analysis were processed by Rev Man 5.0.Results:Browsed 1664 articles about laparoscopic adrenalectomy,fourty studies were found:four randomized controlled trials and thirty six non-randomized controlled trials.enrolled the inclusion criteria in Meta analysis. The baseline of patients' characteristics was comparable in age,sex,proportion,tumor size (p<0.05).By evaluating the relevant indicators, retroperitoneoscopic adrenalectomy has more operative time than open surgery,WMD 95%CI is 20.83[18.86,22.81], blood loss,hospital stay,analgesia doses and complications incidence were significantly less than open adrenalectomy (each p<0.05), each WMD/OR 95%CI is-73.11 [-77.92,-68.29],-3.16[-3.34,-2.97],-2.75[-2.99,-2.51],0.19[0.12,0.31], complications incidence is 0.19 less than open surgery's (p<0.05); retroperitoneoscopic adrenalectomy has less operative time,blood loss and hospital stay than laparoscopic adrenalectomy (each P<0.05), each WMD 95%CI is-8.31 [-9.96,-6.65],-7.12.8[-9.02,-5.21],-0.62[-0.84,-0.39],there are no significantly differences in complications incidence and converstion rate(each p>0.05), each OR 95%CI is 0.75[0.46,1.23],1.59[0.86,2.97].Conclusion:This formal meta-analysis suggests that:Retroperitoneoscopic adrenalectomy is a more effective procedure Compared with open surgery, has some advantages in operative time,blood loss and hospital stay than laparoscopic adrenalectomy.we can select surgical procedure according to the condition of patient.