Laparoscopic versus open surgery for pheochromocytoma: a meta-analysis

Abstract

Background: Surgical resection is the main treatment for pheochromocytoma (PHEO). Although open surgery (OS) has been shown to be safe and feasible, the safety and efficacy of laparoscopic surgery (LS) for PHEO remain controversial due to the uncertain effects of pneumoperitoneum on haemodynamics and the complexity of the tumour itself. This study was performed to compare the treatment outcomes of OS with those of LS for patients with PHEO. Methods: A systematic search through November 11, 2019, was conducted. All studies comparing outcomes of LS and OS for PHEO were included according to eligibility criteria. This meta-analysis was conducted using Review Manager Software, version 5.3, and STATA software, version 12.0. The quality of the included studies was assessed using the Newcastle-Ottawa scale. Results: Fourteen studies involving 626 patients were included in this meta-analysis. LS was associated with lower rates of intraoperative haemodynamic instability (IHD) [odds ratio (OR) = 0.61, 95% CI: 0.37 to 1.00, P = 0.05], less intraoperative blood loss [weighted mean difference (WMD) = − 115.27 ml, 95% confidence interval (CI): − 128.54 to − 101.99, P < 0.00001], lower blood transfusion rates [OR = 0.33, 95% CI: 0.21 to 0.52, P < 0.00001], earlier ambulation (WMD = − 1.57 d, 95% CI: − 1.97 to − 1.16, P < 0.00001) and food intake (WMD = − 0.98 d, 95% CI: − 1.36 to − 0.59, P < 0.00001), shorter drainage tube indwelling time (WMD = − 0.51 d, 95% CI: − 0.96 to − 0.07, P = 0.02) and postoperative stay (WMD = − 3.17 d, 95% CI: − 4.76 to − 1.58, P < 0.0001), and lower overall complication rates (OR = 0.56, 95% CI: 0.35 to 0.88, P = 0.01). However, no significant differences in operative time, postoperative blood pressure control, rates of severe complications, postoperative hypotension or cardiovascular disease (CVD) were found between the two groups. Conclusions: LS is safe and effective for PHEO resection. Compared with OS, LS caused less IHD, providing an equal chance to cure hypertension while also yielding a faster and better postoperative recovery.

Surgical outcomes in the pheochromocytoma surgery. Results from the PHEO-RISK STUDY

“…Genetic information was available in 136 patients, of whom 29.4% had a predisposing hereditary syndrome (the most common MEN2A). 162 surgeries were included (3 patients underwent adrenalectomy twice), laparoscopic adrenalectomy in 156 patients (bilateral in 12), open adrenalectomy in 14 (bilateral in 2 patients). After a median follow-up of 41.2 months, 6 patients died, but only one death was attributable to the pheochromocytoma (progression of metastatic disease).…”

“…risk factors for postsurgical complications included diabetes [4], tumour size [11], preoperative total urinary metanephrine excretion [7], preoperative systolic blood pressure [7] and open adrenalectomy [12], among others.…”

Cardiovascular Presentation in Pheochromocytoma: What We Should be Aware

“…A catecholamine crisis can also lead to heart failure, pulmonary edema, arrhythmias, and intracranial haemorrhage. 6 When we suspect pheochromocytoma, additional examination such as urine or plasma metanephrine levels and imaging studies such as computed tomography (CT) scan and magnetic resonance imaging (MRI) are needed.…”

“…1 Minimal invasive techniques (laparoscopy or retroperitoneoscopy) have become the standard approach to pheochromocytoma surgery due to fewer complications and faster healing than open surgery. 6 Compared to open surgery, minimal invasive techniques only need a small incision, which is related to better cosmetic results. 6…”

Comparison of Perioperative Outcomes of Robotic-Assisted vs Laparoscopic Adrenalectomy for Pheochromocytoma: A Meta-Analysis

“…Since the 1990s, laparoscopic techniques have emerged as an alternative to open surgical approaches ( 5 ). Two recent meta-analyses have confirmed that laparoscopic adrenalectomy (LA) is associated with lower volume of bleeding, lower intraoperative hemodynamic instability (IHD) and better postoperative recovery when used in the treatment of PHEO ( 6 , 7 ). However, because of the limited movement range of the instrument, physiological tremor magnification, and unclear two-dimensional images, it has been suggested that the risk of surgery is increased, especially for large PHEOs ( 8 ).…”