Short-term outcomes in obese and non-obese patients undergoing transperitoneal laparoscopic adrenalectomy for benign or malignant adrenal diseases: an updated systematic review and meta-analysis

Background: Transperitoneal laparoscopic adrenalectomy (TLA) is the most frequently chosen approach in adrenal surgery. At present, impact of obesity on patient outcomes following adrenal surgery is frequently under discussion. We intended to offer updated evidence thanks to a comparison between intraoperative and perioperative outcomes in non-obese and obese patients, who underwent TLA for benign or malignant adrenal diseases. Methods: Our systematic review made use of Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Articles of interest turned out from a search with PubMed/MEDLINE, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials-CENTRAL), Web of Science (Science and Social Science Citation Index), and Scopus databases. We evaluated two groups of outcomes: intraoperative (operative time, intraoperative complications rate, estimated blood loss (EBL), transfusion rate, conversion to open surgery rate) and postoperative (overall postoperative complications rate, major postoperative complications rate, length of hospital stay). RevMan (Computer program) Version 5.4 was used to perform the meta-analysis. The heterogeneity of the included studies in the meta-analysis was assessed by using the I2 statist. Results: The 8 included comparative studies (1,646 patients: 995 non-obese versus 651 obese) had a time frame of approximately 30 years (1994–2020) and an observational nature. Meta-analysis showed no differences in terms of operative time, intraoperative complications rate, EBL, transfusion rate, conversion to open surgery rate, overall postoperative complications rate, major (Clavien-Dindo ≥ III) postoperative complications rate, length of hospital stay between non-obese and obese populations. Conclusions: We can say that obesity does not impact TLA safety and effectiveness. Due to biases among meta-analyzed studies (small overall sample size and small number of events analyzed, in particular), careful interpretation is needed to interpret our results. Additional randomized, possibly multi-center trials may contribute to confirm our results.