Adrenalektomide Perioperatif Sonuçların Öngörülmesi: Neden MAP Skoru BMI’dan Daha Önemlidir?

Year 2025, Volume: 22 Issue: 4

Enis Mert Yorulmaz , Kürşad Dönmez , Serkan Özcan , Osman Köse , Sacit Nuri Görgel , Esra Koç , Yiğit Akın

Abstract

Amaç: Bu çalışma, adrenalektomide cerrahi zorluğu öngörmede Mayo Adezif olasılık (MAP) skorunun klinik yararını değerlendirmeyi ve performansını vücut kitle indeksi (VKİ) ile karşılaştırmayı amaçlamıştır.
Materyal ve metod: 2015-2024 yılları arasında adrenal adenom nedeniyle adrenalektomi uygulanan 161 hasta retrospektif olarak analiz edildi. Hastalar preoperatif MAP skoruna göre düşük (0-1) ve yüksek (2-5) gruplara, VKİ değerine göre ise üç kategoriye (<25, 25-30, >30 kg/m²) ayrıldı. Operasyon süresi, tahmini kan kaybı,hastanede yatış süresi ve dren çekilme zamanı gruplar arasındakarşılaştırıldı.
Bulgular: Yüksek MAP skoruna sahip hastalarda operasyonsüresi (140 vs. 100 dakika, p<0,001), kan kaybı (80 vs. 50 mL,p<0,001), hastanede yatış süresi (8 vs. 7 gün, p=0,010) ve drençekilme zamanı (4 vs. 3 gün, p<0,001) anlamlı olarak dahafazlaydı. VKİ kategorileri arasında ise bu parametreler açısındananlamlı fark saptanmadı.
Sonuç: MAP skoru, adrenalektomide cerrahi zorluklarınöngörülmesinde pratik bir preoperatif risk sınıflama aracı olup,cerrahi karmaşıklığın öngörülmesinde VKİ’ye kıyasla dahagüvenilir sonuçlar sağlamaktadır.

Keywords

Adrenalektomi , Mayo Adezif olasılık skoru , Perioperatif sonuçlar , Vücut kitle indeksi

Perioperative Outcome Prediction in Adrenalectomy: Why MAP Score Matters More Than BMI?

Abstract

Background: This study aimed to evaluate the clinical utility of the Mayo Adhesive probability (MAP) score in predicting surgical difficulty in adrenalectomy and to compare its performance with body mass index (BMI).
Materials and Methods: We retrospectively analyzed 161 patients who underwent adrenalectomy for adrenal adenomas between 2015 and 2024. Patients were categorized into low (0-1) and high (2-5) MAP score groups, and into three BMI categories (<25, 25-30, >30 kg/m²). Operative time, estimated blood loss, hospital stay, and drain removal time were compared across groups.
Results: Patients with high MAP scores had significantly longer operative times (140 vs. 100 minutes, p<0.001), greater blood loss (80 vs. 50 mL, p<0.001), longer hospital stays (8 vs. 7 days, p=0.010), and delayed drain removal (4 vs. 3 days, p<0.001). No significant differences were observed across BMI categories.
Conclusions: The MAP score is a practical preoperative tool for risk stratification in adrenalectomy, providing more reliable prediction of surgical complexity than BMI.

Keywords

Adrenalectomy , Mayo Adhesive probability score , Body mass index , Perioperative outcomes

Ethical Statement

This study was approved by the Health Research Ethics Committee of İzmir Katip Çelebi University (approval no: 0148, date: October 17, 2024).

References

• 1. Nigri G, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, et al. Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery. 2013;153(1):111-119.
• 2. Inaishi T, Kikumori T, Takeuchi D, Ishihara H, Miyajima N, Shibata M, et al. Obesity does not affect peri- and postoperative outcomes of transabdominal laparoscopic adrenalectomy. Nagoya J Med Sci. 2018;80(1):21-28.
• 3. Zhao J, He J, Hong B, Hou Z, Wang Y, Luo Y, et al. Propensity score-matched analysis examining the role of obesity on outcomes in retroperitoneal laparoscopic adrenalectomy: a cohort study. Gland Surg. 2024;13(6):802-811.
• 4. Pearlstein SS, Kuo JH, Chabot JA, Lee JA. Periadrenal Volume is a Better Predictor of Prolonged Operative Time in Laparoscopic Retroperitoneal Adrenalectomy than BMI. World J Surg. 2020;44(2):578-584.
• 5. Erbil Y, Barbaros U, Sari S, Agcaoglu O, Salmaslioglu A, Ozarmagan S. The effect of retroperitoneal fat mass on surgical outcomes in patients performing laparoscopic adrenalectomy: the effect of fat tissue in adrenalectomy. Surg Innov. 2010;17(2):114-119.
• 6. Davidiuk AJ, Parker AS, Thomas CS, Leibovich BC, Castle EP, Heckman MG, et al. Mayo adhesive probability score: an accurate image-based scoring system to predict adherent perinephric fat in partial nephrectomy. Eur Urol. 2014;66(6):1165-1171.
• 7. Yuan Y, Feng H, Kang Z, Xie Y, Zhang X, Zhang Y, et al. Mayo adhesive probability score is associated with perioperative outcomes in retroperitoneal laparoscopic adrenalectomy. ANZ J Surg. 2022;92(12):3273-3277.
• 8. Kira S, Sawada N, Nakagomi H, Ihara T, Furuya R, Takeda M, et al. Mayo Adhesive Probability Score Is Associated with the Operative Time in Laparoscopic Adrenalectomy. J Laparoendosc Adv Surg Tech A. 2022;32(6):595-599.
• 9. Chen W, Fang Q, Ding S, Wu X, Zhang P, Cao J, et al. The Adhesive Perinephric Fat Score is Correlated with Outcomes of Retroperitoneal Laparoscopic Adrenalectomy for Benign Diseases. World J Surg. 2022;46(11):2687-2694.
• 10. Miyamoto T, Hori S, Onishi S, Tomizawa M, Shimizu T, Onishi K, et al. Association of Mayo Adhesive Probability Score With Perioperative Outcomes and Histological Characteristics of Adherent Perinephric Fat in Laparoscopic Adrenalectomy. In Vivo. 2024;38(6):2836-2843.
• 11. Tuncel A, Keten T, Senel C, Erhuner Tengirsenk Z, Ozercan AY, Koseoglu B, et al. Can the Mayo Adhesive Probability Score Predict Perioperative Outcomes in Laparoscopic Total and Partial Adrenalectomy? J Endourol. 2024;38(2):142-149.
• 12. Weir CB, Jan A. BMI Classification Percentile and Cut Off Points. StatPearls Publishing; 2025. Available from: http://www.ncbi.nlm.nih.gov/books/NBK541070/
• 13. Wang J, Yang B, Sun S, Zhang Y. Perioperative factors influencing the difficulty of retroperitoneal laparoscopic adrenalectomy: a single-center retrospective study. BMC Urol. 2022;22(1):25. Available from: https://pubmed.ncbi.nlm.nih.gov/35177059/
• 14. Pearlstein SS, Kuo JH, Chabot JA, Lee JA. Periadrenal Volume is a Better Predictor of Prolonged Operative Time in Laparoscopic Retroperitoneal Adrenalectomy than BMI. World J Surg. 2020;44(2):578-584.
• 15. Hu M, Cai W, Chen Y, Xu X, Wu Y, Lian Y, et al. The modified retroperitoneal laparoscopic adrenalectomy overcomes adhesive periadrenal fat and achieves superior outcomes than classical approach: a retrospective study. BMC Urol. 2025;25(1):143.
• 16. Rahim W, Ullah L, Asim MI, Naseer M, Anwar MB, Azad MH, et al. Association of the Mayo-Adhesive Probability Score With the Total Operative Time of Hand-Assisted Laparoscopic Donor Nephrectomy. Cureus. 2024;16(12):e76166.
• 17. Yao Y, Gong H, Pang Y, Gu L, Niu S, Xu Y, et al. Risk Factors Influencing the Thickness and Stranding of Perinephric Fat of Mayo Adhesive Probability Score in Minimally Invasive Nephrectomy. Med Sci Monit. 2019;25:3825-3831.
• 18. Chen W, Liang Y, Lin W, Fu GQ, Ma ZW. Surgical management of large adrenal tumors: impact of different laparoscopic approaches and resection methods on perioperative and long-term outcomes. BMC Urol. 2018;18(1):31.