Thirty day postoperative outcomes following laparoscopic adrenalectomy for functional adrenal tumors.
Conn’s syndrome
Cushing’s syndrome
Functional adrenal tumors
Laparoscopic adrenalectomy
Pheochromocytoma
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
31
03
2023
accepted:
23
06
2023
medline:
27
9
2023
pubmed:
7
7
2023
entrez:
6
7
2023
Statut:
ppublish
Résumé
Functional adrenal tumors (FATs) are rare and if left untreated, there is a substantial risk of morbidity and mortality due to uncontrolled excess hormone secretion. The three most common FATs are cortisone-producing tumors (hypercortisolism), aldosterone-producing tumors (hyperaldosteronism), and catecholamines-producing tumors (pheochromocytomas). The study aims to evaluate demographic characteristics and 30-day outcomes after laparoscopic adrenalectomy of FATs. Patients who underwent laparoscopic adrenalectomy for FATs were selected from the ACS-NSQIP database (2015-2017), and divided into three groups (hyperaldosteronism, hypercortisolism, and pheochromocytoma). Preoperative demographics, medical comorbidities, and 30-day postoperative outcomes among the three groups were analyzed using the chi-squared test, analysis of variance (ANOVA) and Kruskal-Wallis one-way analysis of variance. Multivariable logistic regression was performed to assess the effects independent variables on the likelihood of increased overall morbidity. Of a total of 2410 patients who underwent laparoscopic adrenalectomy, 345 (14.3%) patients with FATs were included. Patients in the hypercortisolism group were younger, had higher proportion of females, had higher BMI, had a higher proportion of White ethnicity and had a higher proportion of diabetes. The hyperaldosteronism group had a higher proportion of Black ethnicity and a higher proportion of hypertension (HTN) requiring medication. Thirty day postoperative outcomes showed that the pheochromocytoma group had a higher rate of serious morbidity, overall morbidity, and highest readmission rates. There were three deaths, 1 in the pheochromocytoma and 2 in the hypercortisolism groups. Operative time (in minutes) was longer in the hypercortisolism group. Median length of stay was higher in hypercortisolism (2 days) and pheochromocytoma (1.5 day) groups. Functional adrenal tumors show distinct variations in patient demographics and postoperative outcomes. It is essential to use this information during the preoperative period to optimize patients prior to intervention and counsel patients about potential postoperative outcomes.
Sections du résumé
BACKGROUND
Functional adrenal tumors (FATs) are rare and if left untreated, there is a substantial risk of morbidity and mortality due to uncontrolled excess hormone secretion. The three most common FATs are cortisone-producing tumors (hypercortisolism), aldosterone-producing tumors (hyperaldosteronism), and catecholamines-producing tumors (pheochromocytomas). The study aims to evaluate demographic characteristics and 30-day outcomes after laparoscopic adrenalectomy of FATs.
METHODS
Patients who underwent laparoscopic adrenalectomy for FATs were selected from the ACS-NSQIP database (2015-2017), and divided into three groups (hyperaldosteronism, hypercortisolism, and pheochromocytoma). Preoperative demographics, medical comorbidities, and 30-day postoperative outcomes among the three groups were analyzed using the chi-squared test, analysis of variance (ANOVA) and Kruskal-Wallis one-way analysis of variance. Multivariable logistic regression was performed to assess the effects independent variables on the likelihood of increased overall morbidity.
RESULTS
Of a total of 2410 patients who underwent laparoscopic adrenalectomy, 345 (14.3%) patients with FATs were included. Patients in the hypercortisolism group were younger, had higher proportion of females, had higher BMI, had a higher proportion of White ethnicity and had a higher proportion of diabetes. The hyperaldosteronism group had a higher proportion of Black ethnicity and a higher proportion of hypertension (HTN) requiring medication. Thirty day postoperative outcomes showed that the pheochromocytoma group had a higher rate of serious morbidity, overall morbidity, and highest readmission rates. There were three deaths, 1 in the pheochromocytoma and 2 in the hypercortisolism groups. Operative time (in minutes) was longer in the hypercortisolism group. Median length of stay was higher in hypercortisolism (2 days) and pheochromocytoma (1.5 day) groups.
CONCLUSION
Functional adrenal tumors show distinct variations in patient demographics and postoperative outcomes. It is essential to use this information during the preoperative period to optimize patients prior to intervention and counsel patients about potential postoperative outcomes.
Identifiants
pubmed: 37415017
doi: 10.1007/s00464-023-10255-y
pii: 10.1007/s00464-023-10255-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7893-7900Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Beck AC, Goffredo P, Hassan I et al (2018) Risk factors for 30-day readmission after adrenalectomy. Surgery 164(4):766–773. https://doi.org/10.1016/j.surg.2018.04.041
doi: 10.1016/j.surg.2018.04.041
pubmed: 30097166
Conzo G, Musella M, Corcione F et al (2013) Laparoscopic treatment of pheochromocytomas smaller or larger than 6 cm. A clinical retrospective study on 44 patients. Laparoscopic adrenalectomy for pheochromocytoma. Ann Ital Chir 84(4):417–422
pubmed: 23093462
Elfenbein DM, Scarborough JE, Speicher PJ, Scheri RP (2013) Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J Surg Res 184(1):216–220. https://doi.org/10.1016/j.jss.2013.04.014
doi: 10.1016/j.jss.2013.04.014
pubmed: 23664532
Heger P, Probst P, Hüttner FJ et al (2017) Evaluation of open and minimally invasive adrenalectomy: a systematic review and network meta-analysis. World J Surg 41(11):2746–2757. https://doi.org/10.1007/s00268-017-4095-3
doi: 10.1007/s00268-017-4095-3
pubmed: 28634842
Kiernan CM, Shinall MC Jr, Mendez W, Peters MF, Broome JT, Solorzano CC (2014) Influence of adrenal pathology on perioperative outcomes: a multi-institutional analysis. Am J Surg 208(4):619–625. https://doi.org/10.1016/j.amjsurg.2014.06.002
doi: 10.1016/j.amjsurg.2014.06.002
pubmed: 25129428
pmcid: 4172490
Parikh PP, Rubio GA, Farra JC, Lew JI (2017) Nationwide review of hormonally active adrenal tumors highlights high morbidity in pheochromocytoma. J Surg Res 215:204–210. https://doi.org/10.1016/j.jss.2017.04.011
doi: 10.1016/j.jss.2017.04.011
pubmed: 28688648
Chen Y, Scholten A, Chomsky-Higgins K et al (2018) Risk factors associated with perioperative complications and prolonged length of stay after laparoscopic adrenalectomy. JAMA Surg 153(11):1036–1041. https://doi.org/10.1001/jamasurg.2018.2648
doi: 10.1001/jamasurg.2018.2648
pubmed: 30090934
pmcid: 6584328
Poulin EC, Schlachta CM, Burpee SE, Pace KT, Mamazza J (2003) Laparoscopic adrenalectomy: pathologic features determine outcome. Can J Surg 46(5):340–344
pubmed: 14577705
pmcid: 3211702
Di Buono G, Buscemi S, Lo Monte AI et al (2019) Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes. BMC Surg 18(Suppl 1):128. https://doi.org/10.1186/s12893-018-0456-6
doi: 10.1186/s12893-018-0456-6
pubmed: 31074390
pmcid: 7402565
Kim AW, Quiros RM, Maxhimer JB, El-Ganzouri AR, Prinz RA (2004) Outcome of laparoscopic adrenalectomy for pheochromocytomas vs aldosteronomas. Arch Surg 139(5):526–531. https://doi.org/10.1001/archsurg.139.5.526
doi: 10.1001/archsurg.139.5.526
pubmed: 15136353
Kissane NA, Cendan JC (2009) Patients with Cushing’s syndrome are care-intensive even in the era of laparoscopic adrenalectomy. Am Surg 75(4):279–283
doi: 10.1177/000313480907500402
pubmed: 19385284
Sadler C, Goldfarb M (2014) Risk estimator for adrenal tumor functionality. World J Surg 38(8):2019–2024. https://doi.org/10.1007/s00268-014-2524-0
doi: 10.1007/s00268-014-2524-0
pubmed: 24715043
Raval MV, Pawlik TM (2018) Practical guide to surgical data sets: National Surgical Quality Improvement Program (NSQIP) and Pediatric NSQIP. JAMA Surg 153(8):764–765. https://doi.org/10.1001/jamasurg.2018.0486
doi: 10.1001/jamasurg.2018.0486
pubmed: 29617521
Ingraham AM, Cohen ME, Ko CY, Hall BL (2010) A current profile and assessment of north American cholecystectomy: results from the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 211(2):176–186. https://doi.org/10.1016/j.jamcollsurg.2010.04.003
doi: 10.1016/j.jamcollsurg.2010.04.003
pubmed: 20670855
Al-Jalabneh T, Al-Shawabkeh O, Al-Gwairy I et al (2021) Laparoscopic versus open adrenalectomy: a retrospective comparative study. Med Arch 75(1):41–44. https://doi.org/10.5455/medarh.2021.75.41-44
doi: 10.5455/medarh.2021.75.41-44
pubmed: 34012198
pmcid: 8116067
Henneman D, Chang Y, Hodin RA, Berger DL (2009) Effect of laparoscopy on the indications for adrenalectomy. Arch Surg 144(3):255–259. https://doi.org/10.1001/archsurg.2008.564
doi: 10.1001/archsurg.2008.564
pubmed: 19289665
Duralska M, Dzwonkowski J, Sierdziński J, Nazarewski S (2022) High-volume center experience with laparoscopic adrenalectomy over two decades. J Clin Med 11(9):2335. https://doi.org/10.3390/jcm11092335
doi: 10.3390/jcm11092335
pubmed: 35566460
pmcid: 9102790
Öz B, Akcan A, Emek E et al (2016) Laparoscopic surgery in functional and nonfunctional adrenal tumors: a single-center experience. Asian J Surg 39(3):137–143. https://doi.org/10.1016/j.asjsur.2015.04.009
doi: 10.1016/j.asjsur.2015.04.009
pubmed: 26170103
Gotoh M, Ono Y, Hattori R, Kinukawa T, Ohshima S (2002) Laparoscopic adrenalectomy for pheochromocytoma: morbidity compared with adrenalectomy for tumors of other pathology. J Endourol 16(4):245–250. https://doi.org/10.1089/089277902753752223
doi: 10.1089/089277902753752223
pubmed: 12042109
Nau P, Demyttenaere S, Muscarella P et al (2010) Pheochromocytoma does not increase risk in laparoscopic adrenalectomy. Surg Endosc 24(11):2760–2764. https://doi.org/10.1007/s00464-010-1042-x
doi: 10.1007/s00464-010-1042-x
pubmed: 20376497
Ku JH, Yeo WG, Kwon TG, Kim HH (2005) Laparoscopic adrenalectomy for functioning and non-functioning adrenal tumors: analysis of surgical aspects based on histological types. Int J Urol 12(12):1015–1021. https://doi.org/10.1111/j.1442-2042.2005.01203.x
doi: 10.1111/j.1442-2042.2005.01203.x
pubmed: 16409602
Girón F, Rey Chaves CE, Rodríguez L et al (2022) Postoperative outcomes of minimally invasive adrenalectomy: do body mass index and tumor size matter? A single-center experience. BMC Surg 22(1):280. https://doi.org/10.1186/s12893-022-01725-6
doi: 10.1186/s12893-022-01725-6
pubmed: 35854264
pmcid: 9297646