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

INTRODUCTION:A randomized controlled trial was conducted to compare the clinical efficacy of lateral transperitoneal adrenalectomy (LTA) versus posterior retroperitoneoscopic adrenalectomy (PRA) and to explore suitable surgical approaches for different patients. METHODS:This prospective study enrolled 184 adrenal tumor patients treated at our hospital from May 2023 to October 2025. Patients were randomly assigned to the LTA group or PRA group using minimization. Subgroup analyses were performed based on tumor diameter, location, and pathological type to investigate suitable surgical approaches for tumors with different characteristics. The impact of surgeon qualifications on outcomes was examined to indirectly assess the differences in learning curves. Primary outcomes included operative time, laparoscopic operation time, and blood loss. Secondary outcomes included trocar establishment time, number of trocars, transfusion rates, intraoperative complication rates, conversion rates, analgesic requirement grade on postoperative day 1, postoperative antibiotic use, postoperative recovery time of gastrointestinal function, postoperative drainage time, short-term postoperative complication rates, postoperative length of stay, and total hospitalization cost. RESULTS:The LTA and the PRA groups each comprised 92 patients. No significant differences were observed between LTA and PRA for primary outcomes. PRA demonstrated superiority over LTA in the number of trocars (p = 0.006), intraoperative complication rates (p = 0.047), analgesic requirement grade on postoperative day 1 (p = 0.042), postoperative recovery time of gastrointestinal function (p < 0.001), and postoperative drainage time (p < 0.001). When tumor diameter >3 cm, LTA demonstrated superiority in blood loss (p = 0.007) and intraoperative complication rates (p = 0.032). Subgroup analysis showed that LTA had a significantly higher complication rate than PRA (p = 0.027) when treating right adrenal tumors. Surgeon qualifications significantly influenced operative time (p < 0.001), laparoscopic operation time (p = 0.006), and blood loss (p = 0.002) of PRA, but had no apparent effect on perioperative indicators of LTA. CONCLUSION:Both LTA and PRA are safe surgical methods for treating adrenal tumors, but PRA has advantages, especially for right adrenal tumors, where it can significantly reduce the incidence of complications, but it requires a greater technical challenge for the surgeon. For adrenal tumors with a diameter greater than 3 cm, LTA can be considered. Clinicians should comprehensively consider their technical proficiency, patient characteristics, and tumor features when choosing the appropriate surgical method.