BACKGROUND To compare the outcomes of retroperitoneal adrenalectomy with transperitoneal approach for adrenal gland neoplasm.METHODS After an extensive literature search,all compared study and controlled clinical study on transperitoneal and retroperitoneal adrenalectomy with adrenal gland neoplasm were assessed.Those meeting study quality criteria were analyzed to generate summative data expressed by weight mean difference(WMD)and odds ratio(OR).RESULTS After an extensive literature search,all compared study and controlled clinical study on transperitoneal and retroperitoneal adrenalectomy with adrenal gland neoplasm were assessed.Those meeting study quality criteria were analyzed to generate summative data expressed by weight mean difference(WMD)and odds ratio(OR).Ten clinical controlled trials or compared studies on 952 patients qualified for this study.There were 606 patients in retroperitoneal group and 352 patients in the transperitoneal group.In fixed or randomized effects model,retroperitoneal approach was associated with shorter operative time,intra-operative blood loss,duration of hospital stay or time to first ambulation and lower major post-operative complication rate(WMD:-17.77; 95% CI:-28.92 to-6.61,P =.002; WMD:-40.60,95%CI:-79.73 to-1.47,P=.04; WMD:-1.41,95%CI:-2.44 to-.38,P=.007; WMD:-.38,95%CI:-.47 to-.28,P<.01; OR:.48,95%CI:.26 to.88,P=.02).While the difference between both number of convert to open management and time to first oral intake was not significant(WMD:-.31,95%CI:-1.14 to.52,P=.47;OR:.53,95%CI:.17 to 1.60,P=.26).CONCLUSION The present evidence demonstrates that retroperitoneal adrenalectomy is better than transperitoneal approach for patients with adrenal neoplasm in general.More technical demanding,however,might have previously been considered to have insufficient experience in retroperitoneal approach.