Surgical Outcomes of Adrenal Mass Management: A Retrospective Analysis
Year 2024,
Volume: 8 Issue: 2, 152 - 159, 30.08.2024
Hakan Balbaloglu
,
Sakin Tekin
,
Oguzhan Deniz
,
Hatice Tekin
,
Güldeniz Karadeniz Çakmak
,
Mustafa Cömert
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.
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
Hakan Balbaloglu
,
Sakin Tekin
,
Oguzhan Deniz
,
Hatice Tekin
,
Güldeniz Karadeniz Çakmak
,
Mustafa Cömert
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.