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/m(2), 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. (C) 2020 Published by Elsevier Ltd.