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Comparing surgical outcomes of approaches to adrenalectomy - a systematic review and network meta-analysis of randomised clinical trials.
Davey, Matthew G; Ryan, Éanna J; Donlon, Noel E; Ryan, Odhrán K; Al Azzawi, Mohammed; Boland, Michael R; Kerin, Michael J; Lowery, Aoife J.
Afiliación
  • Davey MG; Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland. m.davey7@nuigalway.ie.
  • Ryan ÉJ; Department of Surgery, Galway University Hospitals, Galway, H91YR71, Republic of Ireland. m.davey7@nuigalway.ie.
  • Donlon NE; Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland.
  • Ryan OK; Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland.
  • Al Azzawi M; Surgical Professorial Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland.
  • Boland MR; Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland.
  • Kerin MJ; Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland.
  • Lowery AJ; Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland.
Langenbecks Arch Surg ; 408(1): 180, 2023 May 05.
Article en En | MEDLINE | ID: mdl-37145303
BACKGROUND: No randomised clinical trials (RCTs) have simultaneously compared the safety of open (OA), transperitoneal laparoscopic (TLA), posterior retroperitoneal (PRA), and robotic adrenalectomy (RA) for resecting adrenal tumours. AIM: To evaluate outcomes for OA, TLA, PRA, and RA from RCTs. METHODS: A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. RESULTS: Eight RCTs with 488 patients were included (mean age: 48.9 years). Overall, 44.5% of patients underwent TLA (217/488), 37.3% underwent PRA (182/488), 16.4% underwent RA (80/488), and just 1.8% patients underwent OA (9/488). The mean tumour size was 35 mm in largest diameter with mean sizes of 44.3 mm for RA, 40.9 mm for OA, 35.5 mm for TLA, and 34.4 mm for PRA (P < 0.001). TLA had the lowest blood loss (mean: 50.6 ml), complication rates (12.4%, 14/113), and conversion to open rates (1.3%, 2/157), while PRA had the shortest intra-operative duration (mean: 94 min), length of hospital stay (mean: 3.7 days), lowest visual analogue scale pain scores post-operatively (mean: 3.7), and was most cost-effective (mean: 1728 euros per case). At NMA, there was a significant increase in blood loss for OA (mean difference (MD): 117.00 ml (95% confidence interval (CI): 1.41-230.00)) with similar blood loss observed for PRA (MD: - 10.50 (95% CI: - 83.40-65.90)) compared to TLA. CONCLUSION: LTA and PRA are important contemporary options in achieving favourable outcomes following adrenalectomy. The next generation of RCTs may be more insightful for comparison surgical outcomes following RA, as this approach is likely to play a future role in minimally invasive adrenalectomy. PROSPERO REGISTRATION: CRD42022301005.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Laparoscopía / Neoplasias de las Glándulas Suprarrenales Tipo de estudio: Clinical_trials / Guideline / Systematic_reviews Límite: Humans / Middle aged Idioma: En Revista: Langenbecks Arch Surg Año: 2023 Tipo del documento: Article País de afiliación: Irlanda Pais de publicación: Alemania
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Laparoscopía / Neoplasias de las Glándulas Suprarrenales Tipo de estudio: Clinical_trials / Guideline / Systematic_reviews Límite: Humans / Middle aged Idioma: En Revista: Langenbecks Arch Surg Año: 2023 Tipo del documento: Article País de afiliación: Irlanda Pais de publicación: Alemania