Laparoskopik Adrenalektomi: Tek Merkez Deneyim

Öz

Aim: Laparoscopic adrenalectomy (LA) has become the "gold standard" for treating most adrenal lesions. The purpose of this study was to evaluate the results of 98 consecutive laparoscopic adrenalectomies performed over 15 years at a single center. Materials and methods: Ninety-eight patients who underwent laparoscopic adrenalectomy between 2006 and 2021 at the Izmir Tepecik Training and Research Hospital were included in this retrospective study. Previous abdominal surgery, American Society of Anesthesiologists (ASA) score, tumor size and location, surgical procedures, and postoperative results with histologic diagnosis and complications were analyzed from patient archives. Results: The mean age of the patients was 53.38 ±13.55 years. The mean size of the adrenal lesions was 59.1 (range, 23 to 130) mm. Nineteen (19.4%) patients required conversion to open adrenalectomy. The rate of conversion was found to be significantly higher in patients with intraoperative complications (p<0.001) and lesions larger than 8 cm (p=0.032). The mean length of hospital stay was 6.3 (range, 2-32) days. Discussion and Conclusion:Laparoscopic adrenalectomy is the standard treatment for adrenal lesions. Tumor location, histopathologic type, and the age of the patients should not be considered a contraindication for laparoscopic adrenalectomy. Intraoperative complications and lesions larger than 8 cm are seen as the most important reason for conversion to open adrenalectomy.

Anahtar Kelimeler

• laparoskopic adrenalectomy
• endocrin surgery
• laparoscopic surgery
• adrenalectomy

Laparoscopic Adrenalectomy: A Single-Center’s Experience

Öz

Laparoscopic adrenalectomy (LA) has become the "gold standard" for treating most adrenal lesions. The purpose of this study was to evaluate the results of 98 consecutive laparoscopic adrenalectomies performed over 15 years at a single center. Ninety-eight patients who underwent laparoscopic adrenalectomy between 2006 and 2021 at the Izmir Tepecik Training and Research Hospital were included in this retrospective study. Previous abdominal surgery, American Society of Anesthesiologists (ASA) score, tumor size and location, surgical procedures, and postoperative results with histologic diagnosis and complications were analyzed from patient archives. The mean age of the patients was 53.38 ±13.55 years. The mean size of the adrenal lesions was 59.1 (range, 23 to 130) mm. Nineteen (19.4%) patients required conversion to open adrenalectomy. The rate of conversion was found to be significantly higher in patients with intraoperative complications (p<0.001) and lesions larger than 8 cm (p=0.032). The mean length of hospital stay was 6.3 (range, 2-32) days. Laparoscopic adrenalectomy is the standard treatment for adrenal lesions. Tumor location, histopathologic type, and the age of the patients should not be considered a contraindication for laparoscopic adrenalectomy. Intraoperative complications and lesions larger than 8 cm are seen as the most important reason for conversion to open adrenalectomy.

Anahtar Kelimeler

• laparoscopic adrenalectomy
• laparoscopic surgery
• adrenalectomy
• endocrine surgery

Kaynakça

1. 1. Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med.1992;327:1033.
2. 2. Kahramangil B, Berber E. Comparison of posterior retroperitoneal and transabdominal lateral approaches in robotic adrenalectomy: an analysis of 200 cases. Surg Endosc. 2018;32:1984-9.
3. 3. Öz B, Akcan A, Emek E, Akyüz M, Sözüer E, Akyıldız H, et al. Laparoscopic surgery in functional and nonfunctional adrenal tumors: A single-center experience. Asian J Surg 2016;39:137–43 .
4. 4. Murphy MM, Witkowski ER, Ng SC, McDade TP, Hill JS, Larkin AC, et al. Trends in adrenalectomy: a recent national review. Surg Endosc. 2010;24:2518–26.
5. 5. Wu K, Liu Z, Liang J, Tang Y, Zou Z, Zhou C, et al. Laparoscopic versus open adrenalectomy for localized (stage 1/2) adrenocortical carcinoma: experience at a single, high-volumecenter. Surgery.2018;164:1325–29.
6. 6. Parnaby CN, Chong PS, Chisholm L, Farrow J, Connell JM, O'Dwyer PJ. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc. 2008;22:617–21
7. 7. 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;27:2342–50.
8. 8. Staren ED, Prinz RA. Adrenalectomy in the era of laparoscopy. Surgery. 1996; 120: 706-709.

9. 9. 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: 11-13.
10. 10. Fiszer P, Toutounchi S, Pogorzelski R, Krajewska E, Sutkowski B, Gierej P, Skórski M. Is tumour size a contraindication to laparoscopic adrenalectomy? Case report. Wideochir Inne Tech Maloinwazyjne. 2012;7:144-6.
11. 11. C.N. Parnaby, P.S. Chong, L. Chisholm, J. Farrow, J.M. Connell, P.J. O'Dwyer. The role of laparoscopic adrenalectomy for adrenal tumours of 6 cm or greater. Surg Endosc. 2008; 22: 617– 21.
12. 12. G.N. Zografos, A. Farfaras, G. Vasiliadis, T. Pappa, C. Aggeli, E. Vassilatou, et al. Laparoscopic resection of large adrenal tumors. JSLS. 2010; 14: 364– 68.
13. 13. Vidal O, Saavedra-Perez D, Martos JM, de la Quintana A, Rodriguez JI, Villar J, et al. Risk factors for open conversion of lateral transperitoneal laparoscopic adrenalectomy: retrospective cohort study of the Spanish Adrenal Surgery Group (SASG). Surg Endosc. 2020;34:3690-95.
14. 14. Gunjur A, Duong C, Ball D, Siva S. Surgical and ablative therapies for the management of adrenal ‘oligometastases’ – A systematic review. Cancer Treat Rev 2014; 40: 838-46 15. Vazquez BJ, Richards ML, Lohse CM, Thompson GB, Farley DR, Grant CS, et al. Adrenalectomy improves outcomes of selected patients with metastatic carcinoma. World J Surg. 2012:36:1400-5. 16. Moreno P, de la Quintana Basarrate A, Musholt TJ, Paunovic I, Puccini M, Vidal O, et al. Adrenalectomy for solid tumor metastases: results of a multicenter European study. Surgery. 2013 ;154:1215-22; discussion 1222-3. 17. Saunders BD, Doherty GM. Laparoscopic adrenalectomy for malignant disease. Lancet Oncol. 2004;5:718-26.
15. 18. Shen WT, Sturgeon C, Duh QY. From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J Surg Oncol. 2005;89:186-92.
16. 19. Panis Y, Maggiori L, Caranhac G, Bretagnol F, Vicaut E. Mortality after colorectal cancer surgery: a French survey of more than 84,000 patients. Ann Surg. 2011;254:738-43; discussion 743-4.
17. 20. Brozzetti S, Mazzoni G, Miccini M, Puma F, De Angelis M, Cassini D, et al. Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg. 2006;141:137-42.
18. 21. Weinandt M, Gaujoux S, Khayat A, Bertherat J, Baillard C, Dousset B. Laparoscopic Adrenalectomy in Elderly Patients. Surg Laparosc Endosc Percutan Tech. 2017;27:e132-e135.
19. 22. Blake MA, Holalkere NS, Boland GW. Imaging techniques for adrenal lesion characterization. Radiol Clin North Am 2008;46:65-78,
20. 23. Mayo-Smith W.W., Song J.H., Boland G.L., Francis I.R., Israel G.M., Mazzaglia P.J., et al. Management of Incidental Adrenal Masses: A White Paper of the ACR Incidental Findings Committee. J. Am. Coll. Radiol. 2017;14:1038–44.
21. 24. Chen Y, Scholten A, Chomsky-Higgins K, Nwaogu I, Gosnell JE, Seib C, Shen WT, Suh I, Duh QY. Risk Factors Associated With Perioperative Complications and Prolonged Length of Stay After Laparoscopic Adrenalectomy. JAMA Surg. 2018;153:1036-1041.
22. 25. Gupta PK, Natarajan B, Pallati PK, Gupta H, Sainath J, Fitzgibbons RJ Jr. Outcomes after laparoscopic adrenalectomy. Surg Endosc. 2011;25:784-94.
23. 26. Sommerey S, Foroghi Y, Chiapponi C, Baumbach SF, Hallfeldt KKJ, Ladurner R, et al. Laparoscopic adrenalectomy-10-year experience at a teaching hospital. Langenbecks Arch Surg 400:341–47
24. 27. Köstek M, Aygün N, Uludağ M. Laparoscopic Approach to the Adrenal Masses: Single-Center Experience of Five Years. Sisli Etfal Hastan Tip Bul. 2020 ;54:52-57.
25. 28. Rodríguez-Hermosa JI, Delisau O, Planellas-Giné P, Cornejo L, Ranea A, Maldonado E, et al. Factors associated with prolonged hospital stay after laparoscopic adrenalectomy. Updates Surg. 2021;73:693-702.
26. 29. Strebel RT, Müntener M, Sulser T. Intraoperative complications of laparoscopic adrenalectomy. World J Urol. 2008;26:555-60.