title: Retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adrenal tumor: a meta-analysis.
abstract: BACKGROUND
  The study aims to provide a pooled meta-analysis of existing studies that compare the outcomes of retroperitoneal laparoscopic adrenalectomy with transperitoneal approach for adrenal tumor.
  
  
  METHODS
  A systematic search of electronic databases was performed and studies were selected based on specific inclusion and exclusion criteria. Data of interest were subjected to meta-analysis using randomized or fixed-effect model to calculate weight mean difference (WMD) or odds ratio (OR). The sensitivity analysis and publication bias test also be conducted.
  
  
  RESULTS
  Nine observational studies with 632 patients were identified (339 retroperitoneal vs. 293 transperitoneal). Retroperitoneal approach was associated with shorter operative time [WMD=-13.10; 95% confidence interval (CI), -23.83 to -2.36; P=0.02], less intraoperative blood loss (WMD=-40.60; 95% CI, -79.73 to -1.47; P=0.04), shorter duration of hospital stay (WMD=-1.25; 95% CI, -2.36 to -0.14; P=0.03), or time to first ambulation (WMD=-0.38; 95% CI, -0.47 to -0.28; P<0.001). Although the difference between number of convert to open management, time to first oral intake, and major postoperative complication rate was not significant (OR=0.53; 95% CI, 0.17 to 1.60; P=0.26; WMD=-0.31; 95% CI, -1.14 to 0.52; P=0.47; OR=0.41; 95% CI, 0.06 to 1.06; P=0.07).
  
  
  CONCLUSIONS
  The present evidence demonstrates that retroperitoneal adrenalectomy is better than transperitoneal approach for patients with adrenal tumor in short-term outcomes. However, extended follow-ups and further randomized controlled trials should be required to analysis.
authors.affiliation: Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Fei
authors.initials: F
authors.lastname: Li
authors.forename: Dingnan
authors.initials: D
authors.lastname: Chen
authors.forename: Yongtong
authors.initials: Y
authors.lastname: Zhu
authors.forename: Chengwu
authors.initials: C
authors.lastname: He
authors.forename: Yuejun
authors.initials: Y
authors.lastname: Du
authors.forename: Wanlong
authors.initials: W
authors.lastname: Tan
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D061214:Patient Safety; D010529:Peritoneal Cavity / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D012187:Retroperitoneal Space / Q000601:surgery; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome