ORIGINAL PAPER
Indications for laparoscopic adrenalectomy as a determinant of the perioperative and postoperative course: a retrospective, single-centre cohort study
1
Department of Urology, Holycross Cancer Centre, Kielce, Poland
2
Collegium Medicum, Jan Kochanowski University, Kielce, Poland
3
Department of Endocrinology, Holycross Cancer Centre, Kielce, Poland
4
Department of Clinical Oncology, Holycross Cancer Centre, Kielce, Poland
These authors had equal contribution to this work
Submission date: 2023-11-04
Acceptance date: 2023-11-22
Publication date: 2023-12-30
Corresponding author
Łukasz Niedziela
Łukasz Niedziela MD Department of Urology Holycross Cancer Centre Collegium Medicum Jan Kochanowski University Kielce, Poland
Łukasz Niedziela MD Department of Urology Holycross Cancer Centre Collegium Medicum Jan Kochanowski University Kielce, Poland
Medical Studies 2023;39(4):311-318
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Laparoscopic adrenalectomy (LA) is a widely used method for the surgical management of adrenal tumours.
Aim of the research:
To compare the perioperative and postoperative course in patients with adrenal lesions based on indications for LA.
Material and methods:
We conducted a retrospective, single-centre data analysis of patients undergoing LA between January 2015 and December 2021. The patients were divided into 4 cohorts, depending on endocrine and oncological indications: (1) hormonally active tumours, (2) non-functioning tumours measuring < 40 mm with suspected radiologic features, (3) non-functioning tumours measuring ≥ 40 mm, and (4) metastases. We established our outcomes on clinical characteristics (age, sex, BMI, Charlson Comorbidity Index (CCI), ASA score, smoking history), perioperative data (side, operation time, blood loss, intraoperative complications, conversion to open surgery, time of drainage, and duration of hospital stay), and postoperative data (histopathological report, 30-day complication rate).
Results:
A total of 140 patients were included in the study. Comparative analysis of the groups showed differences in ASA score, smoking history, and CCI. The mean operating time was 112 min, and it was significantly longer in the group of patients with adrenal metastases (149 min, p = 0.002). Intraoperative complications were observed in 5 (3.6%) patients, conversion to open surgery was performed 3 times (2.1%). No life-threatening complications were observed in the postoperative period.
Conclusions:
LA is a safe method of surgical treatment of adrenal tumours. Removal of adrenal metastases is an advanced laparoscopic procedure that requires an experienced surgeon. The course of treatment depends on the qualification and preparation of patients for the procedure by a multidisciplinary team.
Laparoscopic adrenalectomy (LA) is a widely used method for the surgical management of adrenal tumours.
Aim of the research:
To compare the perioperative and postoperative course in patients with adrenal lesions based on indications for LA.
Material and methods:
We conducted a retrospective, single-centre data analysis of patients undergoing LA between January 2015 and December 2021. The patients were divided into 4 cohorts, depending on endocrine and oncological indications: (1) hormonally active tumours, (2) non-functioning tumours measuring < 40 mm with suspected radiologic features, (3) non-functioning tumours measuring ≥ 40 mm, and (4) metastases. We established our outcomes on clinical characteristics (age, sex, BMI, Charlson Comorbidity Index (CCI), ASA score, smoking history), perioperative data (side, operation time, blood loss, intraoperative complications, conversion to open surgery, time of drainage, and duration of hospital stay), and postoperative data (histopathological report, 30-day complication rate).
Results:
A total of 140 patients were included in the study. Comparative analysis of the groups showed differences in ASA score, smoking history, and CCI. The mean operating time was 112 min, and it was significantly longer in the group of patients with adrenal metastases (149 min, p = 0.002). Intraoperative complications were observed in 5 (3.6%) patients, conversion to open surgery was performed 3 times (2.1%). No life-threatening complications were observed in the postoperative period.
Conclusions:
LA is a safe method of surgical treatment of adrenal tumours. Removal of adrenal metastases is an advanced laparoscopic procedure that requires an experienced surgeon. The course of treatment depends on the qualification and preparation of patients for the procedure by a multidisciplinary team.
REFERENCES (31)
1.
Gagner M, Lacroix A, Prinz RA, Bolté E, Albala D, Potvin C, Hamet P, Kuchel O, Quérin S, Pomp A. Early experience with laparoscopic approach for adrenalectomy. Surgery 1993; 114: 1120-1124.
2.
Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 1997; 226: 238-246.
3.
Heslin MJ, Winzeler AH, Weingarten JO, Diethelm AG, Urist MM, Bland KI. Laparoscopic adrenalectomy and splenectomy are safe and reduce hospital stay and charges. Am Surg 2003; 69: 377-381.
4.
Stefanidis D, Goldfarb M, Kercher KW, Hope WW, Richardson W, Fanelli RD. SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc 2013; 27: 3960-3980.
5.
Mihai R, Donatini G, Vidal O, Brunaud L. Volume-outcome correlation in adrenal surgery-an ESES consensus statement. Langenbecks Arch Surg 2019; 404: 795-806.
6.
Desai MM, Gill IS, Kaouk JH, Matin SF, Sung GT, Bravo EL. Robotic-assisted laparoscopic adrenalectomy. Urology 2002; 60: 1104-1107.
7.
Ball MW, Hemal AK, Allaf ME. International Consultation on Urological Diseases and European Association of Urology International Consultation on Minimally Invasive Surgery in Urology: laparoscopic and robotic adrenalectomy. BJU Int 2017; 119: 13-21.
8.
Morino M, Benincà G, Giraudo G, Del Genio GM, Rebecchi F, Garrone C. Robot-assisted vs laparoscopic adrenalectomy: a prospective randomized controlled trial. Surg Endosc 2004; 18: 1742-1746.
9.
Ma W, Mao Y, Zhuo R, Dai J, Fang C, Wang C, Zhao J, He W, Zhu Y, Xu D, Sun F. Surgical outcomes of a randomized controlled trial compared robotic versus laparoscopic adrenalectomy for pheochromocytoma. Eur J Surg Oncol 2020; 46: 1843-1847.
10.
Bednarczuk T, Bolanowski M, Sworczak K, Górnicka B, Cieszanowski A, Otto M, Ambroziak U, Pachucki J, Kubicka E, Babińska A, Koperski Ł, Januszewicz A, Prejbisz A, Górska M, Jarząb B, Hubalewska-Dydejczyk A, Glinicki P, Ruchała M, Kasperlik-Załuska A. Adrenal incidentaloma in adults - management recommendations by the Polish Society of Endocrinology. Endokrynol Pol 2016; 67: 234-258.
11.
Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 2016; 175: G1-G34.
12.
Bittner JG 4th, Brunt LM. Evaluation and management of adrenal incidentaloma. J Surg Oncol 2012; 106: 557-564.
13.
Wachtel H, Roses RE, Kuo LE, Lindeman BM, Nehs MA, Tavakkoli A, Parangi S, Hodin RA, Fraker DL, James BC, Carr AA, Wang TS, Solórzano CC, Lubitz CC. Adrenalectomy for secondary malignancy: patients, outcomes, and indications. Ann Surg 2021; 274: 1073-1080.
14.
Gaujoux S, Mihai R on behalf of the joint working group of ESES and ENSAT. European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma. Br J Surg 2017; 104: 358-376.
15.
Fassnacht M, Dekkers OM, Else T, Baudin E, Berruti A, de Krijger R, Haak HR, Mihai R, Assie G, Terzolo M. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 2018; 179: G1-G46.
16.
Sinclair TJ, Gillis A, Alobuia WM, Wild H, Kebebew E. Surgery for adrenocortical carcinoma: when and how? Best Pract Res Clin Endocrinol Metab 2020; 34: 101408.
17.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383.
18.
R Core Team (2021). _R: A Language and Environment for Statistical Computing_. R Foundation for StatisticalComputing, Vienna, Austria. https://www.R-project.org/>.
19.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213.
20.
Tariel F, Dourmap C, Prudhomme T, Hascoet J, Soulie M,Moreau B, Thoulouzan M, Vezzosi D, Guenego A, Manunta A, Huyghe E, Peyronnet B. Adrenalectomy for pheochromocytoma: complications and predictive factors of intraoperative hemodynamic instability. Am Surg 2023; 89: 4772-1779.
21.
Urabe F, Kimura S, Iwatani K, Takahashi K, Ito K, Tashiro K, Tsuzuki S, Miki J, Kimura T, Furuta N, Egawa S. Risk factors for perioperative hemodynamic instability in pheochromocytoma: a systematic review and meta-analysis. J Clin Med 2021; 10: 4531.
22.
Mínguez Ojeda C, Gómez Dos Santos V, Álvaro Lorca J, Ruz-Caracuel I, Pian H, Sanjuanbenito Dehesa A, Burgos Revilla FJ, Araujo-Castro M. Tumour size in adrenal tumours: its importance in the indication of adrenalectomy and in surgical outcomes-a single-centre experience. J Endocrinol Invest 2022; 45: 1999-2006.
23.
Seidenwurm DJ, Elmer EB, Kaplan LM, Williams EK, Morris DG, Hoffman AR. Metastases to the adrenal glands and the development of Addison’s disease. Cancer 1984; 54: 552-557. .
24.
Dudani S, de Velasco G, Wells JC, Gan CL, Donskov F, Porta C, Fraccon A, Pasini F, Lee JL, Hansen A, Bjarnason GA, Beuselinck B, Pal SK, Yuasa T, Kroeger N, Kanesva-ran R, Reaume MN, Canil C, Choueiri TK, Heng DYC. Evaluation of clear cell, papillary, and chromophobe renal cell carcinoma metastasis sites and association with survival. JAMA Netw Open 2021; 4: e2021869.
25.
Spartalis E, Drikos I, Ioannidis A, Chrysikos D, Athanasiadis DI, Spartalis M, Avgerinos D. Metastatic carcinomas of the adrenal glands: from diagnosis to treatment. Anticancer Res 2019; 39: 2699-2710.
26.
Natkaniec M, Dworak J, Pędziwiatr M, Pisarska M, Major P, Dembiński M, Winiarski M, Budzyński A. Patients criteria determining difficulty of the laparoscopic lateral transperitoneal adrenalectomy. A retrospective cohort study. Int J Surg 2017; 43: 33-37.
27.
Battistella E, Ferrari S, Pomba L, Toniato A. Adrenal surgery: Review of 35 years experience in a single centre. Surg Oncol 2021; 37: 101554.
28.
Duralska M, Dzwonkowski J, Sierdziński J, Nazarewski S. High-volume center experience with laparoscopic adrenalectomy over two decades. J Clin Med 2022; 11: 23-35.
29.
Pędziwiatr M, Wierdak M, Ostachowski M, Natkaniec M, Białas M, Hubalewska-Dydejczyk A, Matłok M, Major P, Budzyński P, Migaczewski M, Budzyński A. Single center outcomes of laparoscopic transperitoneal lateral adrenalectomy--lessons learned after 500 cases: a retrospective cohort study. Int J Surg 2015; 20: 88-94.
30.
Coste T, Caiazzo R, Torres F, Vantyghem MC, Carnaille B, Do Cao C, Douillard C, Pattou F. Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience. Surg Endosc 2017; 31: 2743-2751.
31.
Alberici L, Paganini AM, Ricci C, Balla A, Ballarini Z, Ortenzi M, Casole G, Quaresima S, Di Dalmazi G, Ursi P, Alfano MS, Selva S, Casadei R, Ingaldi C, Lezoche G, Guerrieri M, Minni F, Tiberio GAM. Development and validation of a preoperative “difficulty score” for laparoscopic transabdominal adrenalectomy: a multicenter retrospective study. Surg Endosc 2022; 36: 3549-3557.
Share
RELATED ARTICLE
| eISSN: | 2300-6722 |
| ISSN: | 1899-1874 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
