Comparison of retroperitoneal laparoscopic versus open adrenalectomy for large pheochromocytoma: a single-center retrospective study

Abstract

Background It remains unclear whether retroperitoneal laparoscopic adrenalectomy (RLA) is safe and effective for the treatment of large pheochromocytoma (PHEO). This retrospective study aimed to identify the advantages and disadvantages of RLA compared to open adrenalectomy (OA). Methods This study included 147 patients who underwent RLA ( n = 101) or OA ( n = 46) for PHEO larger than 5 cm. Groups were balanced by propensity score matching (PSM) into 46 pairs. Perioperative variables and long-term follow-up results were compared between the two groups. Results After PSM, patients in the RLA group had a shorter operative time (218 vs. 245 min, P = 0.040), quicker bowel recovery (2 vs. 3 days, P = 0.046), and a shorter hospital stay (8 vs. 9 days, P = 0.010) compared to the OA group. The results of multiple linear regression analyses showed that the operative method (OA vs. RLA) had an influence on the above three postoperative variables ( β = 31.84, P = 0.046; β = 0.76, P = 0.044; and β = 1.25, P = 0.025, respectively). There was no significant difference in the proportion of patients with improved blood pressure (82.61% vs. 69.57%, P = 0.143) between the two groups. Conclusions Both RLA and OA provide similar perioperative and long-term outcomes for the surgical management of large PHEO. RLA is an efficacious and safe surgical method for patients with PHEO larger than 5 cm in diameter.

Laparoscopic versus open surgery for pheochromocytoma: a meta-analysis

“…CVD: cardiovascular disease; LS: laparoscopic surgery; OS: open surgery; CI: confidence interval [33]. In fact, there are few reports on laparoscopic resection of large PHEO [5,13,27,31,32,34,35]. An important note is that in all of the studies included in our meta-analysis, the majority of the tumours removed by LS were smaller than 6 cm and that all the results of this meta-analysis are based on this fact.…”

“…3 a). Time to resumption of eating was reported in six studies [ 13 , 23 – 27 ], and the time to recovery of diet in the LS group was significantly shorter than that in the OS group (WMD = − 0.98 d, 95% CI: − 1.36 to − 0.59, P < 0.00001, I 2 = 86% for heterogeneity, P < 0.00001; Fig. 3 b).…”

“…After removing duplicates, the remaining 469 relevant studies were further screened, and 253 were eliminated by scanning the titles and abstracts; full text review was performed on 32 articles. After reviewing the full text, 14 studies that met the criteria were included in the meta-analysis [ 6 – 8 , 13 , 18 – 27 ]. A flow chart of the literature retrieval summary is depicted in Fig.…”

“…3 b). Three studies described the drainage tube indwelling time in 156 patients [ 8 , 26 , 27 ]; the drainage tube was removed earlier in the LS group than in the OS group after surgery (WMD = − 0.51 d, 95% CI: − 0.96 to − 0.07, P = 0.02, I 2 = 0% for heterogeneity, P = 0.41; Fig. 3 c).…”

“…3 c). Nine studies including 480 patients presented postoperative hospital stays [ 8 , 13 , 19 , 20 , 22 – 24 , 26 , 27 ], and meta-analysis these data revealed shorter stays in the LS group than in the OS group (WMD = − 3.17 d, 95% CI: − 4.76 to − 1.58, P < 0.0001, I 2 = 90% for heterogeneity, P < 0.00001; Fig. 3 d).…”