Lateral Transperitoneal Versus Posterior Retroperitoneoscopic Adrenalectomy for Adrenal Tumors: A Randomized Controlled Trial.

In 30 seconds

This prospective randomised controlled trial compared lateral transperitoneal adrenalectomy (LTA) with posterior retroperitoneoscopic adrenalectomy (PRA) in 184 patients with adrenal tumors. The groups each included 92 patients, and neither approach differed significantly on the primary outcomes of operative time, laparoscopic operation time, or blood loss. PRA had advantages in several secondary outcomes, including fewer intraoperative complications overall (p = 0.047), while subgroup results favoured LTA for blood loss (p = 0.007) and intraoperative complications (p = 0.032) when tumors exceeded 3 cm. Surgeon qualifications influenced PRA outcomes.

Key findings

• No significant between-group differences were found in operative time, laparoscopic operation time, or blood loss overall.
• PRA was associated with fewer trocars (p = 0.006), fewer intraoperative complications (p = 0.047), and faster gastrointestinal recovery and shorter drainage time (both p < 0.001).
• For tumors >3 cm, LTA had lower blood loss (p = 0.007) and fewer intraoperative complications (p = 0.032).
• Surgeon qualifications significantly affected PRA operative time (p < 0.001), laparoscopic operation time (p = 0.006), and blood loss (p = 0.002).

Why it matters

The findings suggest that the two operative routes have different perioperative profiles rather than a clear overall advantage on primary outcomes. Tumor size and location, alongside the surgeon’s experience, may be relevant when weighing an approach. These subgroup findings can inform discussion of procedural trade-offs, while requiring interpretation in the context of the trial’s setting and outcomes.

What to keep in mind

The study was conducted at one hospital, and the abstract reports short-term perioperative outcomes rather than longer-term outcomes.