Conversion During Laparoscopic Adrenalectomy for Pheochromocytoma: A Cohort Study in 244 Patients.
Adrenalectomy
Conversion
Laparoscopy
Morbidity
Mortality
Pheochromocytoma
Postoperative complications
Journal
The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
05
11
2018
revised:
02
05
2019
accepted:
29
05
2019
pubmed:
30
6
2019
medline:
1
2
2020
entrez:
30
6
2019
Statut:
ppublish
Résumé
Recent advances in anesthetic and laparoscopic surgical management have improved perioperative outcomes in patients with pheochromocytoma. However, patients converted to laparotomy during laparoscopic adrenalectomy for pheochromocytoma have never been evaluated specifically in terms of intraoperative hemodynamic instability and postoperative complications. Retrospective analysis of prospectively maintained databases in five medical centers from 2002 to 2013. Inclusion criteria were consecutive patients who underwent laparoscopic unilateral total adrenalectomy for pheochromocytoma. Two hundred forty-four patients were included. Mean tumor size was 43.9 ± 20 mm with 92 patients (38%) having a tumor diameter > 50 mm. During adrenalectomy, 19 of 244 patients (7.7%) had to be converted to laparotomy. In multivariable analysis, the need for preoperative hospitalization (3.379, 1.209-9.445; P = 0.020), tumor size > 6 cm (2.97, 0.996-8.868; P = 0.050), and ratio of intraoperative systolic blood pressure >200 mmHg duration to anesthesia duration (1.060, 1.007-1.117; P = 0.027) remained significantly associated with conversion. Conversion was significantly associated with postoperative grade II-V Clavien morbidity rate (4.259, 1.471-12.326; P = 0.007) and duration of hospitalization (12.92, 2.90-58.82; P < 0.001). This study shows that preoperative hospitalization and larger tumor were more frequent in patients undergoing conversion to laparotomy during laparoscopic adrenalectomy for pheochromocytoma. Conversion is associated with increased intraoperative hypertensive episodes and postoperative complications rate. Clinicians should be cognizant of these risks and prepare patients appropriately for conversion when deemed necessary.
Sections du résumé
BACKGROUND
Recent advances in anesthetic and laparoscopic surgical management have improved perioperative outcomes in patients with pheochromocytoma. However, patients converted to laparotomy during laparoscopic adrenalectomy for pheochromocytoma have never been evaluated specifically in terms of intraoperative hemodynamic instability and postoperative complications.
METHODS
Retrospective analysis of prospectively maintained databases in five medical centers from 2002 to 2013. Inclusion criteria were consecutive patients who underwent laparoscopic unilateral total adrenalectomy for pheochromocytoma.
RESULTS
Two hundred forty-four patients were included. Mean tumor size was 43.9 ± 20 mm with 92 patients (38%) having a tumor diameter > 50 mm. During adrenalectomy, 19 of 244 patients (7.7%) had to be converted to laparotomy. In multivariable analysis, the need for preoperative hospitalization (3.379, 1.209-9.445; P = 0.020), tumor size > 6 cm (2.97, 0.996-8.868; P = 0.050), and ratio of intraoperative systolic blood pressure >200 mmHg duration to anesthesia duration (1.060, 1.007-1.117; P = 0.027) remained significantly associated with conversion. Conversion was significantly associated with postoperative grade II-V Clavien morbidity rate (4.259, 1.471-12.326; P = 0.007) and duration of hospitalization (12.92, 2.90-58.82; P < 0.001).
CONCLUSIONS
This study shows that preoperative hospitalization and larger tumor were more frequent in patients undergoing conversion to laparotomy during laparoscopic adrenalectomy for pheochromocytoma. Conversion is associated with increased intraoperative hypertensive episodes and postoperative complications rate. Clinicians should be cognizant of these risks and prepare patients appropriately for conversion when deemed necessary.
Identifiants
pubmed: 31254904
pii: S0022-4804(19)30371-3
doi: 10.1016/j.jss.2019.05.042
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
309-315Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.