Obesity and postoperative outcomes of the patients with laparoscopic adrenalectomy: a systematic review and meta-analysis

Abstract

Background: Studies have suggested differences in postoperative outcomes between patients with obesity and those without following adrenalectomy, but these remained to be ascertained with synthesis of available evidence. The aim of this systematic review and meta-analysis was to investigate the association between obesity and outcomes of patients after laparoscopic adrenalectomy. Methods: We searched EMBASE, PubMed, Global Index Medicus, and Web of Science, without language restriction, to identify cohort studies published between January 1, 2000 and November 6, 2019. We considered studies with data comparing outcomes of adults with and without obesity after laparoscopic adrenalectomy. Random-effects meta-analysis was used to pool study-specific estimates. This review was registered with PROSPERO, CRD42018117070. Results: Five studies with data on a pooled sample of 353 patients with obesity and 828 without were included in the meta-analysis. The risk of bias was moderate to low. We found no association between obesity and the various stages of postoperative complications: Clavien-Dindo grade 1 (OR = 1.57; 95%CI = 0.55-4.48; I 2 = 44.6%), grade 2 (OR = 1.12; 95%CI = 0.54-2.32; I 2 = 0.0%), grade 3 (OR = 1.79; 95%CI = 0.58-5.47; I 2 = 0.0%;), grade 4 (OR = 0.43; 95%CI = 0.05-3.71; I 2 = 0.0%), and grade 5 (death) (OR = 0.43; 95% CI = 0.02-14.31). Furthermore, no association was found between obesity and readmission rates (OR = 0.7; 95% CI = 0.13-3.62) and conversion of laparoscopic to open surgery (OR = 0.62; 95% CI = 0.16-2.34; I 2 = 19.5%). Conclusions: This study suggests that obesity is not associated with complications following laparoscopic adrenalectomy. This meta-analysis might have been underpowered to detect a true association between obesity and patient outcome after laparoscopic adrenalectomy due to the small number of included studies. Larger studies are needed to clarify the role of obesity in patients undergoing laparoscopic adrenalectomy.

Minimally invasive adrenalectomy: a comprehensive systematic review and network meta-analysis of phase II/III randomized clinical controlled trials

“…This study had some limitations. Firstly, the number of included patients was smaller than other meta-analyses available [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. Nonetheless, the present study remains the only meta-analysis including exclusively RCTs, providing high-quality evidence about minimally invasive adrenalectomy.…”

“…Moreover, we analyzed the studies in a network format. Besides, even if several meta-analysis [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] has been produced in the last 20 years, all were affected by two major limitations: a) the bias due to non-randomized studies included; b) the difficulty to obtain clear evidence about the best technique due to the multi-arm setting. Our systematic review included only 6 phase II/III RCTs involving 359 patients because all high-risk studies were discharged.…”

Impact of Excess Body Weight on Postsurgical Complications

“…Presently, according to evidence-based international guidelines, the laparoscopic approach is the standard in bariatric surgery. These data are supported by a meta-analysis by Danwang et al [64] on outcomes of laparoscopic adrenalectomies, a procedure which is a well-established minimally invasive surgery showing no impact of obesity on postsurgical complications but also does only analyze the data from retrospective studies with an overall low number of patients included.…”

“…Second, apart from patient-related factors, the heterogeneity of surgical procedures and complications in the field of visceral surgery make it unlikely for excess body weight to be a universal risk factor. The site and type of surgery [10], the approach to the abdominal cavity (laparoscopic vs. open) [11], institutional factors such as individual surgical training and expertise [12], the type of perioperative care such as fast-track concepts [13], or the enhanced recovery after surgery (ERAS) protocol may all play an important role [14] in determining postsurgical complications. The purpose of this review therefore is to address the impact of excess weight and possible patient-, surgery-, and institutional-related factors on surgical outcomes.…”

Postoperative outcomes of minimally invasive adrenalectomy: do body mass index and tumor size matter? A single-center experience

“…In surgery, risk factors analysis is a cornerstone for decreasing postoperative complications; in metabolic surgery, this is not an exception. Multiple authors tried to evaluate the influence of BMI or tumor volume on the postoperative outcomes, and in cases of adrenalectomies, drug usage and blood pressure changes after surgery are frequently used as the main outcomes [ 18 , 19 ]. However, this topic is still a matter of research.…”