Research Article
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Surgical Outcomes of Adrenal Mass Management: A Retrospective Analysis

Year 2024, Volume: 8 Issue: 2, 152 - 159, 30.08.2024
https://doi.org/10.29058/mjwbs.1443992

Abstract

Aim: The shift towards laparoscopic adrenalectomy (LA) in treating adrenal tumors marks a significant advancement due to its minimally invasive nature, providing enhanced patient outcomes including reduced pain, shorter hospital stays, and lower complication rates compared to open adrenalectomy (OA). This study aims to enrich the literature by presenting a detailed analysis of our adrenalectomy experiences, focusing on patient outcomes, perioperative metrics, and complication rates, to underscore the evolution of our surgical techniques and their significance in enhancing patient care in the realm of adrenal tumor management.
Material and Methods: Conducting a retrospective analysis at Bülent Ecevit University Hospital, we examined the outcomes, complications, and perioperative metrics of adrenalectomies. Out of 31 LA patients, 14 underwent conversion to OA, focusing on assessing the procedure's effectiveness and the influence of different factors on surgical choices and results.
Results: Demographic analysis revealed no significant variance between patients continuing with LA versus those converted to OA. The conversion was primarily driven by larger tumor sizes, emphasizing procedural difficulties. Predominant reasons for conversion included bleeding, insufficient exposure, and adhesions, indicating the technical intricacies and complication risks of LA. This underscores the pivotal role of surgical skill in technique selection.
Conclusion: Despite the challenges, LA stands as the preferred method for managing adrenal tumors, given its benefits over OA. The conversion to OA, heavily reliant on surgical expertise and faced intraoperative issues, highlights the imperative for mastery in LA. Future research should focus on refining LA methods, reducing conversions, and advancing patient care.

Ethical Statement

The study was approved by the Ethics Committee of Zonguldak Bulent Ecevit University, protocol number:( 2024/02-5).

Supporting Institution

This study did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sector.

Thanks

None

References

  • 1. Bittner JG 4th, Gershuni VM, Matthews BD, Moley JF, Brunt LM. Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of 402 patients. Surg Endosc 2013;27(7):2342-2350.
  • 2. Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 1992;327(14):1033.
  • 3. Mercan S, Seven R, Ozarmagan S, Tezelman S. Endoscopic retroperitoneal adrenalectomy. Surgery 1995;118(6):1071-5.
  • 4. Öz B, Akcan A, Emek E, Akyüz M, Sözüer E, Akyıldız H, Bayram A, Kulu R, Ok E. Laparoscopic surgery in functional and nonfunctional adrenal tumors: A single-center experience. Asian J Surg 2016;39(3):137-43.
  • 5. Fiszer P, Toutounchi S, Pogorzelski R, Krajewska E, Cieśla W, Skórski M. Laparoscopic adrenalectomy--assessing the learning curve. Pol Przegl Chir 2012;84(6):293-7.
  • 6. Guerrieri M, Campagnacci R, De Sanctis A, Baldarelli M, Coletta M, Perretta S. The learning curve in laparoscopic adrenalectomy. J Endocrinol Invest 2008;31(6):531-6.
  • 7. Stefanidis D, Goldfarb M, Kercher KW, Hope WW, Richardson W, Fanelli RD; Society of Gastrointestinal and Endoscopic Surgeons. SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc 2013;27(11):3960-80.
  • 8. Fassnacht M, Tsagarakis S, Terzolo M, Tabarin A, Sahdev A, Newell-Price J, Pelsma I, Marina L, Lorenz K, Bancos I, Arlt W, Dekkers OM. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2023;189(1):G1-G42.
  • 9. Elfenbein DM, Scarborough JE, Speicher PJ, Scheri RP. Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J Surg Res 2013;184(1):216-20.
  • 10. Hou Q, Zhang B, Luo Y, Wang P, Yang S, Shang P. Predictive Factors for Conversion from Laparoscopic Adrenalectomy to Open Surgery: A 9-Year Review of 911 Cases. J Laparoendosc Adv Surg Tech A 2023;33(1):38-43.
  • 11. Thompson LH, Nordenström E, Almquist M, Jacobsson H, Bergenfelz A. Risk factors for complications after adrenalectomy: results from a comprehensive national database. Langenbecks Arch Surg 2017;402(2):315-322.
  • 12. Staren ED, Prinz RA. Adrenalectomy in the era of laparoscopy. Surgery 1996;120(4):706-9; discussion 710-1.
  • 13. Gupta PK, Natarajan B, Pallati PK, Gupta H, Sainath J, Fitzgibbons RJ Jr. Outcomes after laparoscopic adrenalectomy. Surg Endosc 2011;25(3):784-94.
  • 14. Ibragimovich KS, Bazarbaevich BU, Parpijalilovich SD. Our Experience Videoendoscopic Adrenalectomy in Patients with Benign Adrenal Tumors Large Sizes. American Journal of Medicine and Medical Sciences 2017;7(1):11–13.
  • 15. Fiori C, Checcucci E, Amparore D, Cattaneo G, Manfredi M, Porpiglia F. Adrenal tumours: open surgery versus minimally invasive surgery. Curr Opin Oncol 2020;32(1):27-34.
  • 16. Machado NO, Al Qadhi H, Al Wahaibi K, Rizvi SG. Laparoscopic Adrenalectomy for Large Adrenocortical Carcinoma. JSLS 2015;19(3):e2015.00036.
  • 17. Strebel RT, Müntener M, Sulser T. Intraoperative complications of laparoscopic adrenalectomy. World J Urol 2008;26(6):555- 60.
  • 18. Eto M, Harano M, Koga H, Tanaka M, Naito S. Clinical outcomes and learning curve of a laparoscopic adrenalectomy in 103 consecutive cases at a single institute. Int J Urol. 2006 Jun;13(6):671-6.
  • 19. Sebastian M, Rudnicki J. Recommendation for laparoscopic ultrasound guided laparoscopic left lateral transabdominal adrenalectomy. Gland Surg 2020;9(3):689-694.
  • 20. Weinandt M, Gaujoux S, Khayat A, Bertherat J, Baillard C, Dousset B. Laparoscopic Adrenalectomy in Elderly Patients. Surg Laparosc Endosc Percutan Tech 2017;27(6):e132-e135.
  • 21. Zhang Z, Wang L, Chen J, Li X, Liu D, Cao T, Yang X, Huang H, Wang X, Song X, Yang D, Wang J. Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases). World J Surg Oncol 2019;17(1):220.

Adrenal Kitle Tedavisinde Cerrahi Sonuçlar: Retrospektif Bir Analiz

Year 2024, Volume: 8 Issue: 2, 152 - 159, 30.08.2024
https://doi.org/10.29058/mjwbs.1443992

Abstract

Amaç: Adrenal tümörlerin tedavisinde laparoskopik adrenalektomiye (LA) geçiş, minimal invaziv doğası nedeniyle önemli bir ilerlemeye işaret etmekte ve açık adrenalektomiye (OA) kıyasla daha az ağrı, daha kısa hastanede kalış süresi ve daha düşük komplikasyon oranları gibi gelişmiş hasta sonuçları sağlamaktadır. Bu çalışma, cerrahi tekniklerimizin gelişimini ve adrenal tümör yönetimi alanında hasta bakımını iyileştirmedeki önemini vurgulamak için hasta sonuçlarına, perioperatif ölçümlere ve komplikasyon oranlarına odaklanarak adrenalektomi deneyimlerimizin ayrıntılı bir analizini sunarak literatürü zenginleştirmeyi amaçlamaktadır.
Gereç ve Yöntemler: Bülent Ecevit Üniversitesi Hastanesi'nde retrospektif bir analiz yaparak, adrenalektomilerin sonuçlarını, komplikasyonlarını ve perioperatif ölçümlerini inceledik. 31 LA hastasından 14'ünde OA'ya dönüşüm yapıldı ve prosedürün etkinliğini ve farklı faktörlerin cerrahi seçimler ve sonuçlar üzerindeki etkisini değerlendirmeye odaklanıldı.
Bulgular: Demografik analiz, LA ile devam eden hastalar ile OA'ya dönüştürülenler arasında anlamlı bir farklılık olmadığını ortaya koydu. Dönüşüm öncelikle daha büyük tümör boyutlarından kaynaklanmış ve prosedürel zorlukları vurgulamıştır. Dönüşümün başlıca nedenleri arasında kanama, yetersiz ekspojur ve yapışıklıklar yer almakta olup, bu durum LA'nın teknik karmaşıklıklarını ve komplikasyon risklerini göstermektedir. Bu durum, cerrahi becerinin önemli rolünün altını çizmektedir.
Sonuç: Zorluklarına rağmen LA, OA'ya göre avantajları göz önüne alındığında, adrenal tümörlerin tedavisinde tercih edilen yöntem olarak durmaktadır. Cerrahi uzmanlığa büyük ölçüde bağımlı olan ve intraoperatif sorunlarla karşılaşan OA'ya dönüşüm, LA'da ustalaşmanın zorunluluğunu vurgulamaktadır. Gelecekteki araştırmalar LA yöntemlerini iyileştirmeye, açık cerrahiye dönüşümleri azaltmaya ve hasta bakımını ilerletmeye odaklanmalıdır.

References

  • 1. Bittner JG 4th, Gershuni VM, Matthews BD, Moley JF, Brunt LM. Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of 402 patients. Surg Endosc 2013;27(7):2342-2350.
  • 2. Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 1992;327(14):1033.
  • 3. Mercan S, Seven R, Ozarmagan S, Tezelman S. Endoscopic retroperitoneal adrenalectomy. Surgery 1995;118(6):1071-5.
  • 4. Öz B, Akcan A, Emek E, Akyüz M, Sözüer E, Akyıldız H, Bayram A, Kulu R, Ok E. Laparoscopic surgery in functional and nonfunctional adrenal tumors: A single-center experience. Asian J Surg 2016;39(3):137-43.
  • 5. Fiszer P, Toutounchi S, Pogorzelski R, Krajewska E, Cieśla W, Skórski M. Laparoscopic adrenalectomy--assessing the learning curve. Pol Przegl Chir 2012;84(6):293-7.
  • 6. Guerrieri M, Campagnacci R, De Sanctis A, Baldarelli M, Coletta M, Perretta S. The learning curve in laparoscopic adrenalectomy. J Endocrinol Invest 2008;31(6):531-6.
  • 7. Stefanidis D, Goldfarb M, Kercher KW, Hope WW, Richardson W, Fanelli RD; Society of Gastrointestinal and Endoscopic Surgeons. SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc 2013;27(11):3960-80.
  • 8. Fassnacht M, Tsagarakis S, Terzolo M, Tabarin A, Sahdev A, Newell-Price J, Pelsma I, Marina L, Lorenz K, Bancos I, Arlt W, Dekkers OM. European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2023;189(1):G1-G42.
  • 9. Elfenbein DM, Scarborough JE, Speicher PJ, Scheri RP. Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J Surg Res 2013;184(1):216-20.
  • 10. Hou Q, Zhang B, Luo Y, Wang P, Yang S, Shang P. Predictive Factors for Conversion from Laparoscopic Adrenalectomy to Open Surgery: A 9-Year Review of 911 Cases. J Laparoendosc Adv Surg Tech A 2023;33(1):38-43.
  • 11. Thompson LH, Nordenström E, Almquist M, Jacobsson H, Bergenfelz A. Risk factors for complications after adrenalectomy: results from a comprehensive national database. Langenbecks Arch Surg 2017;402(2):315-322.
  • 12. Staren ED, Prinz RA. Adrenalectomy in the era of laparoscopy. Surgery 1996;120(4):706-9; discussion 710-1.
  • 13. Gupta PK, Natarajan B, Pallati PK, Gupta H, Sainath J, Fitzgibbons RJ Jr. Outcomes after laparoscopic adrenalectomy. Surg Endosc 2011;25(3):784-94.
  • 14. Ibragimovich KS, Bazarbaevich BU, Parpijalilovich SD. Our Experience Videoendoscopic Adrenalectomy in Patients with Benign Adrenal Tumors Large Sizes. American Journal of Medicine and Medical Sciences 2017;7(1):11–13.
  • 15. Fiori C, Checcucci E, Amparore D, Cattaneo G, Manfredi M, Porpiglia F. Adrenal tumours: open surgery versus minimally invasive surgery. Curr Opin Oncol 2020;32(1):27-34.
  • 16. Machado NO, Al Qadhi H, Al Wahaibi K, Rizvi SG. Laparoscopic Adrenalectomy for Large Adrenocortical Carcinoma. JSLS 2015;19(3):e2015.00036.
  • 17. Strebel RT, Müntener M, Sulser T. Intraoperative complications of laparoscopic adrenalectomy. World J Urol 2008;26(6):555- 60.
  • 18. Eto M, Harano M, Koga H, Tanaka M, Naito S. Clinical outcomes and learning curve of a laparoscopic adrenalectomy in 103 consecutive cases at a single institute. Int J Urol. 2006 Jun;13(6):671-6.
  • 19. Sebastian M, Rudnicki J. Recommendation for laparoscopic ultrasound guided laparoscopic left lateral transabdominal adrenalectomy. Gland Surg 2020;9(3):689-694.
  • 20. Weinandt M, Gaujoux S, Khayat A, Bertherat J, Baillard C, Dousset B. Laparoscopic Adrenalectomy in Elderly Patients. Surg Laparosc Endosc Percutan Tech 2017;27(6):e132-e135.
  • 21. Zhang Z, Wang L, Chen J, Li X, Liu D, Cao T, Yang X, Huang H, Wang X, Song X, Yang D, Wang J. Clinical analysis of adrenal lesions larger than 5 cm in diameter (an analysis of 251 cases). World J Surg Oncol 2019;17(1):220.
There are 21 citations in total.

Details

Primary Language English
Subjects General Surgery
Journal Section Research Article
Authors

Hakan Balbaloglu 0000-0002-0706-3288

Sakin Tekin 0000-0002-1408-1249

Oguzhan Deniz 0000-0002-6976-3490

Hatice Tekin 0000-0002-3940-9167

Güldeniz Karadeniz Çakmak 0000-0001-5802-4441

Mustafa Cömert 0000-0002-8168-0858

Publication Date August 30, 2024
Submission Date February 27, 2024
Acceptance Date July 30, 2024
Published in Issue Year 2024 Volume: 8 Issue: 2

Cite

Vancouver Balbaloglu H, Tekin S, Deniz O, Tekin H, Karadeniz Çakmak G, Cömert M. Surgical Outcomes of Adrenal Mass Management: A Retrospective Analysis. Med J West Black Sea. 2024;8(2):152-9.

Medical Journal of Western Black Sea is a scientific publication of Zonguldak Bulent Ecevit University Faculty of Medicine.

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This journal is published three annually in April, August and December.
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