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Evaluation of Open and Minimally Invasive Adrenalectomy: A Systematic Review and Network Meta-analysis

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Abstract

Background

Adrenalectomy can be performed via open and various minimally invasive approaches. The aim of this systematic review was to summarize the current evidence on surgical techniques of adrenalectomy.

Methods

Systematic literature searches (MEDLINE, EMBASE, Web of Science, Cochrane Library) were conducted to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing at least two surgical procedures for adrenalectomy. Statistical analyses were performed, and meta-analyses were conducted. Furthermore, an indirect comparison of RCTs and a network meta-analysis of CCTs were carried out for each outcome.

Results

Twenty-six trials (1710 patients) were included. Postoperative complication rates did not show differences for open and minimally invasive techniques. Operation time was significantly shorter for open adrenalectomy than for the robotic approach (p < 0.001). No differences were found between laparoscopic and robotic approaches. Network meta-analysis showed open adrenalectomy to be the fastest technique. Blood loss was significantly reduced in the robotic arm compared with open and laparoscopic adrenalectomy (p = 0.01). Length of hospital stay (LOS) was significantly lower after conventional laparoscopy than open adrenalectomy in CCTs (p < 0.001). Furthermore, both retroperitoneoscopic (p < 0.001) and robotic access (p < 0.001) led to another significant reduction of LOS compared with conventional laparoscopy. This difference was not consistent in RCTs. Network meta-analysis revealed the lowest LOS after retroperitoneoscopic adrenalectomy.

Conclusion

Minimally invasive adrenalectomy is safe and should be preferred over open adrenalectomy due to shorter LOS, lower blood loss, and equivalent complication rates. The retroperitoneoscopic access features the shortest LOS and operating time. Further high-quality RCTs are warranted, especially to compare the posterior retroperitoneoscopic and the transperitoneal robotic approach.

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Funding

There was no funding available for this study. However, the resources of the University of Heidelberg have been used to conduct this study.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Patrick Heger, Pascal Probst, Felix J. Hüttner, Käthe Gooßen, Beat P. Müller-Stich, Oliver Strobel, Markus W. Büchler & Markus K. Diener

  2. The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Patrick Heger, Pascal Probst, Felix J. Hüttner, Käthe Gooßen & Markus K. Diener

  3. Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany

    Tanja Proctor

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  1. Patrick Heger
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Correspondence to Markus K. Diener.

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Conflict of interest

Patrick Heger, Pascal Probst, Felix J. Hüttner, Käthe Gooßen, Tanja Proctor, Beat P. Müller-Stich, Oliver Strobel, Markus W. Büchler, and Markus K. Diener have no conflicts of interest or financial ties to disclose.

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Heger, P., Probst, P., Hüttner, F.J. et al. Evaluation of Open and Minimally Invasive Adrenalectomy: A Systematic Review and Network Meta-analysis. World J Surg 41, 2746–2757 (2017). https://doi.org/10.1007/s00268-017-4095-3

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