Propensity Score Matched Analysis Comparing Robotic-Assisted with Laparoscopic Posterior Retroperitoneal Adrenalectomy

Ma, Wenqi; Mao, Yongxin; Dai, Jun; Alimu, Parehe; Zhuo, Ran; He, Wei; Zhao, Juping; Xu, Danfeng; Sun, Fenyong

doi:10.1080/08941939.2020.1770377

Cited by 9 publications

(5 citation statements)

References 32 publications

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“…The cumulative revealed no statistically significant disparity in the occurrence of blood loss (five studies; p = 0.25) ( 15 , 16 , 18 – 20 ). Likewise, no substantial difference emerged in the prevalence of transfusion rate between RPRA and LPRA (p = 0.14, three studies) ( Figure 3 ) ( 15 , 16 , 18 ). The frequency of conversion to open surgery was documented in five studies.…”

Section: Resultsmentioning

confidence: 87%

“…Moreover, the rates of major complications were 1.3% (2 out of 146 cases) for RPRA and 1.4% (3 of 214 cases) for LPRA. Similarly, no statistically significant differences were identified in the occurrence of major complications between RPRA and LPRA (four studies; p = 0.57) ( Figure 5 ) ( 15 – 18 ).…”

Section: Resultsmentioning

confidence: 87%

“…The frequency of conversion to open surgery was documented in five studies. However, the aggregated analysis did not reveal any statistically significant disparities in the reduction of conversion to open surgery between RPRA and LPRA (p = 0.71) ( Figure 4 ) ( 14 , 15 , 17 , 18 , 20 ).…”

Section: Resultsmentioning

confidence: 92%

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Robotic posterior retroperitoneal adrenalectomy versus laparoscopic posterior retroperitoneal adrenalectomy: outcomes from a pooled analysis

Li,

Chen,

Wang

et al. 2023

Front. Endocrinol.

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BackgroundThe comparative advantages of robotic posterior retroperitoneal adrenalectomy (RPRA) over laparoscopic posterior retroperitoneal adrenalectomy (LPRA) remain a topic of ongoing debate within the medical community. This systematic literature review and meta-analysis aim to assess the safety and efficacy of RPRA compared to LPRA, with the ultimate goal of determining which procedure yields superior clinical outcomes.MethodsA systematic search was conducted on databases including PubMed, Embase, Web of Science, and the Cochrane Library database to identify relevant studies, encompassing both randomized controlled trials (RCTs) and non-RCTs, that compare the outcomes of RPRA and LPRA. The primary focus of this study was to evaluate perioperative surgical outcomes and complications. Review Manager 5.4 was used for this analysis. The study was registered with PROSPERO (ID: CRD42023453816).ResultsA total of seven non-RCTs were identified and included in this study, encompassing a cohort of 675 patients. The findings indicate that RPRA exhibited superior performance compared to LPRA in terms of hospital stay (weighted mean difference [WMD] -0.78 days, 95% confidence interval [CI] -1.46 to -0.10; p = 0.02). However, there were no statistically significant differences observed between the two techniques in terms of operative time, blood loss, transfusion rates, conversion rates, major complications, and overall complications.ConclusionRPRA is associated with a significantly shorter hospital stay compared to LPRA, while demonstrating comparable operative time, blood loss, conversion rate, and complication rate. However, it is important to note that further research of a more comprehensive and rigorous nature is necessary to validate these findings.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=453816, identifier CRD42023453816.

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Section: Resultsmentioning

confidence: 87%

Section: Resultsmentioning

confidence: 87%

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Robotic posterior retroperitoneal adrenalectomy versus laparoscopic posterior retroperitoneal adrenalectomy: outcomes from a pooled analysis

Li,

Chen,

Wang

et al. 2023

Front. Endocrinol.

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“…Similar to transabdominal approach, the PRA can be performed robotically or laparoscopically with similar outcomes [17 ▪ ,18]. A propensity score-matched study comparing robotic and laparoscopic PRA adrenalectomies reported no difference in surgical complications, operative time, and estimated blood loss between the two approaches [19]. Figure 3 shows patient position for PRA.…”

Section: Retroperitoneoscopic Adrenalectomymentioning

confidence: 99%

Surgical approaches to the adrenal gland

Sada

McKenzie

2023

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewReview the literature on the surgical management of adrenal diseases, highlighting the various surgical approaches and their respective pros and cons. Recent findingsMinimally invasive adrenalectomy is commonly used for small and benign adrenal tumors, whereas open adrenalectomy is preferred for larger tumors and primary adrenal malignancy. Although minimally invasive adrenalectomy results in shorter recovery and fewer complications compared with open, the latter offers better oncologic outcomes in the setting of primary adrenal malignancy. Adrenalectomy is performed transabdominally or retroperitoneoscopically, both yielding equivalent results and recovery. Traditional laparoscopic or robotic equipment can be utilized for either minimally invasive approach. Subtotal adrenalectomy may be appropriate for patients with genetically associated pheochromocytoma to preserve cortical function and reduce the risk of adrenal insufficiency. However, the potential benefits of sparing adrenal function must be weighed against the risk of recurrence. SummaryAdrenalectomy is becoming increasingly common worldwide. For benign and small adrenal tumors, minimally invasive adrenalectomy is generally considered the standard approach, while open adrenalectomy is preferred for primary adrenal malignancy and larger tumors. Subtotal adrenalectomy may be appropriate for patients with bilateral adrenal pheochromocytoma, as it can reduce the need for lifelong glucocorticoid dependency.

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“…108 However, results can contradict. 109,110 Advances in diagnostics have shown that bilateral disease is more often than previously assumed. Thus, partial adrenalectomy (PA) should always be considered in the case of familial PCC due to the minimal likelihood of ipsilateral recurrence and avoidance of chronic glucocorticoid replacement.…”

Section: Treatment and Managementmentioning

confidence: 99%

Pheochromocytoma: a changing perspective and current concepts

Kiriakopoulos,

Giannakis,

Menenakos

2023

Therapeutic Advances in Endocrinology

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This article aims to review current concepts in diagnosing and managing pheochromocytoma and paraganglioma (PPGL). Personalized genetic testing is vital, as 40–60% of tumors are linked to a known mutation. Tumor DNA should be sampled first. Next-generation sequencing is the best and most cost-effective choice and also helps with the expansion of current knowledge. Recent advancements have also led to the increased incorporation of regulatory RNA, metabolome markers, and the NETest in PPGL workup. PPGL presentation is highly volatile and nonspecific due to its multifactorial etiology. Symptoms mainly derive from catecholamine (CMN) excess or mass effect, primarily affecting the cardiovascular system. However, paroxysmal nature, hypertension, and the classic triad are no longer perceived as telltale signs. Identifying high-risk subjects and diagnosing patients at the correct time by using appropriate personalized methods are essential. Free plasma/urine catecholamine metabolites must be first-line examinations using liquid chromatography with tandem mass spectrometry as the gold standard analytical method. Reference intervals should be personalized according to demographics and comorbidity. The same applies to result interpretation. Threefold increase from the upper limit is highly suggestive of PPGL. Computed tomography (CT) is preferred for pheochromocytoma due to better cost-effectiveness and spatial resolution. Unenhanced attenuation of >10HU in non-contrast CT is indicative. The choice of extra-adrenal tumor imaging is based on location. Functional imaging with positron emission tomography/computed tomography and radionuclide administration improves diagnostic accuracy, especially in extra-adrenal/malignant or familial cases. Surgery is the mainstay treatment when feasible. Preoperative α-adrenergic blockade reduces surgical morbidity. Aggressive metastatic PPGL benefits from systemic chemotherapy, while milder cases can be managed with radionuclides. Short-term postoperative follow-up evaluates the adequacy of resection. Long-term follow-up assesses the risk of recurrence or metastasis. Asymptomatic carriers and their families can benefit from surveillance, with intervals depending on the specific gene mutation. Trials primarily focusing on targeted therapy and radionuclides are currently active. A multidisciplinary approach, correct timing, and personalization are key for successful PPGL management.

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Propensity Score Matched Analysis Comparing Robotic-Assisted with Laparoscopic Posterior Retroperitoneal Adrenalectomy

Cited by 9 publications

References 32 publications

Robotic posterior retroperitoneal adrenalectomy versus laparoscopic posterior retroperitoneal adrenalectomy: outcomes from a pooled analysis

Robotic posterior retroperitoneal adrenalectomy versus laparoscopic posterior retroperitoneal adrenalectomy: outcomes from a pooled analysis

Surgical approaches to the adrenal gland

Pheochromocytoma: a changing perspective and current concepts

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