Üç Yüz Yirmibeş Laparoskopik Adrenalektomi Vakasının Retrospektif Analizi: Tek Merkez Deneyimi

Öz

Kliniğimizde çeşitli adrenal bez patolojileri nedeniyle laparoskopik adrenalektomi (LA) uygulanan hastaların intra-operatif ve post-operatif sonuçlarını değerlendirmeyi amaçladık. 2008 - 2020 yılları arasında LA uygulanan hastaların verileri retrospektif olarak değerlendirildi. Hastaların yaş, cinsiyet gibi demografik özellikleri, adrenal kitlenin boyutu, operasyon süresi, kanama miktarı, preop ve postop hemoglobin değerleri, hastanede kalış süresi, intraoperatif ve postoperatif komplikasyonlar açısından değerlendirildi. Patoloji raporları incelenerek kaydedildi. Çalışmaya 196’sı (%60.3) kadın ve 129’u erkek olmak üzere toplam 325 hasta dahil edildi. Yüz elliyedi hastaya sağ ve 168 (%51.7) hastaya sol LA uygulandı. Ortalama yaş 51.6 ± 12.1 ve ortalama kitle boyutu 40.3 ± 20.2 mm idi. Ortalama operasyon süresi 97 ± 36.2 dk ve ortalama kanama miktarı 50.8 ± 44.1 ml idi. Ortalama hastanede kalış süresi 3.1 ± 2.2 gün idi. İntraoperatif dönemde bir hastada distal pankreas yaralanması, 2 hastada kanama ile toplam 3 hastada intra-operatif komplikasyon gelişti. Bir hastda açık cerrahiye geçildi. Post-operatif dönemde 7 hastada komplikasyon görüldü. Tüm postoperatif komplikasyonlar ek girişime gerek kalmadan konservatif izlem ile tedavi edildi. LA, adrenal kitlelerin cerrahi tedavisinde tecrübeli merkezlerde güvenle uygulanabilecek efektif ve minimal invazif bir tedavi yöntemdir.

Anahtar Kelimeler

• Adrenal kitle
• laparoskopik adrenalektomi
• sonuçlar

Retrospective Analysis of 325 Laparoscopic Adrenalectomy Cases: Single Center Experience

Öz

We aimed to evaluate intraoperative and postoperative outcomes of the patients who underwent laparoscopic adrenalectomy (LA) for various adrenal gland pathologies in our clinic. The data of patients who underwent LA between 2008 and 2020 were evaluated retrospectively. The demographic characteristics of the patients such as age and gender, size of the adrenal mass, operation time, estimated blood loss, preoperative and postoperative hemoglobin, length of hospital stay, intraoperative and postoperative complications were evaluated. Pathology reports were examined and recorded. A total of 325 patients, 196 (60.3%) female and 129 male, were included to study. Right LA was applied to 157 patients and left LA to 168 (51.7%) patients. The mean age was 51.6 ± 12.1 years and the mean tumor size was 40.3 ± 20.2 mm. The mean operation time was 97 ± 36.2 minutes and the mean estimated blood loss was 50.8 ± 44.1 ml. Mean length of hospital stay was 3.1 ± 2.2 days. In the intraoperative period, distal pancreatic injury in one patient, bleeding due to vascular injury in 2 patients, at totally, intra-operative complications developed in 3 patients. In one patient conversion to open surgery was needed. Complications were seen in 7 patients in the post-operative period. All post-operative complications were treated with conservative follow-up without the need for additional intervention. LA is an effective and minimally invasive treatment method that can be safely applied in experienced centers in the surgical treatment of adrenal tumors.

Anahtar Kelimeler

• Adrenal tumor
• laparoscopic adrenalectomy
• outcomes

Kaynakça

1. Rieder JM, Nisbet AA, Wuerstle MC, Tran VQ, Kwon EO, Chien GW. Differences in left and right laparoscopic adrenalectomy. JSLS 2010;14(3):369-73.
2. 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.
3. Gupta PK, Natarajan B, Pallati PK, et al.: Outcomes after laparoscopic adrenalectomy. Surg endosc 2011; 25(3): 784-94.
4. Brix D, Allolio B, Fenske W, et al. Laparoscopic versus open adrenalectomy for adrenocortical carcinoma: surgical and oncologic outcome in 152 patients, Eur. Urol 2010;58:609-15.
5. Wang HS, Li CC, Chou YH, Wang CJ, Wu WJ, Huang CH. Comparison of laparoscopic adrenalectomy with open surgery for adrenal tumors. Kaohsiung J Med Sci 2009;25:438–44.
6. Vargas HI, Kavoussi LR, Bartlett DL, et al. Laparoscopic adrenalectomy: A new standard of care. Urology 1997;49:673–78.
7. Gagner M, Lacroix A, Bolte´ E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 1992;327:1033.
8. Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: new gold standard. World J Surg 1999 Apr;23(4):389-96.

9. Gumbs AA, Gagner M. Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metab 2006 Sep;20(3):483-99.
10. Agrusa A, Romano G, Frazzetta G, et al. Laparoscopic adrenalectomy for large adrenal masses: single team experience. Int J Surg 2014;12 Suppl 1:S72-4.
11. Erbil Y, Barbaros U, Karaman G, Bozbora A, Ozarmağan S. The change in the principle of performing laparoscopic adrenalectomy from small to large masses. Int J Surg 2009 Jun;7(3):266-71.
12. Maccabee DL, Jones A, Domreis J, Deveney CW, Sheppard BC. Transition from open to laparoscopic adrenalectomy: the need for training. Surg Endosc 2003;10:1566-9.
13. Reynolds FD, Goudas L, Zuckerman RS, Gold MS, Heneghan S. A rural community based program can train surgical residents in advanced laparoscopy. J Am Coll Surg 2003;4:620-3.
14. Pędziwiatr M, Wierdak M, Ostachowski M, et al. Single center outcomes of laparoscopic transperitoneal lateral adrenalectomy--Lessons learned after 500 cases: A retrospective cohort study. Int J Surg. 2015 Aug;20:88-94.
15. Murphy MM, Witkowski ER, Ng SC, et al. Trends in adrenalectomy: a recent national review. Surg Endosc 2010;24:2518–26.
16. Miller BS, Gauger PG, Hammer GD, Doherty GM. Resection of adrenocortical carcinoma is less complete and local recurrence occurs sooner and more often after laparoscopic adrenalectomy than after open adrenalectomy. Surgery 2012;152:1150-7.
17. Cooper AB, Habra MA, Grubbs EG, et al. Does laparoscopic adrenalectomy jeopardize oncologic outcomes for patients with adrenocortical carcinoma? Surg Endosc 2013;27:4026-32.
18. Cicek MC, Gunseren KO, Senol K, Vuruskan H, Yavascaoglu I. Is 6 cm Diameter an Upper Limit for Adrenal Tumors to Perform Laparoscopic Adrenalectomy? J Laparoendosc Adv Surg Tech A 2021;31(3):301-5.
19. Sautter AE, Cunningham SC, Kowdley GC. Laparoscopic Adrenalectomy for Adrenal Cancer-A Systematic Review. Am Surg 2016;82(5):420-6.
20. Suzuki K, Kageyama S, Hirano Y, et al. Comparison of 3 surgical approaches to laparoscopic adrenalectomy: a nonrandomized, background matched analysis. J Urol 2001;166:437–43.
21. Alemanno G, Bergamini C, Prosperi P, Valeri A. Adrenalectomy: indications and options for treatment. Updates Surg 2017;69(2):119-25.
22. Bozkurt IH, Arslan M, Yonguc T, et al. Laparoscopic adrenalectomy for large adrenal masses: Is it really more complicated? Kaohsiung J Med Sci. 2015 Dec;31(12):644-8.
23. Di Buono G, Buscemi S, Lo Monte AI, et al. Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes. BMC Surg 2019;18:128.
24. Nguyen PH, Keller JE, Novitsky YW, Heniford BT, Kercher KW. Laparoscopic approach to adrenalectomy: Review of perioperative outcomes in a Single Center. Am Surg 2011;77:592-6.
25. Conzo G, Pasquali D, Della Pietra D, et al. Laparoscopic adrenal surgery: ten-year experience in a single institution. BMC Surg 2013;13 suppl2:S5.
26. Balla A, Palmieri L, Meoli F, et al. Are adrenal lesions of 6 cm or more in diameter a contraindication to laparoscopic adrenalectomy? A case control study. World J Surg 2020;44:810-8.
27. 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;44:578-84.
28. Tiberio GAM, Solaini L, Arru L, Merigo G, Baiocchi GL, Giulini SM. Factors influencing outcomes in laparoscopic adrenal surgery. Langenbecks Arch Surg 2013;398:735-43.
29. Zhu W, Wang S, Du G, Liu H, Lu J, Yang W. Comparison of retroperitoneal laparoscopic versus open adrenalectomy for large pheochromocytoma: a single-center retrospective study. World J Surg Oncol. 2019;17(1):111.
30. Chen Y, Scholten A, Chomsky-Higgins K, et al. Risk factors associated with perioperative complications and prolonged length of stay after laparoscopic adrenalectomy. JAMA Surg 2018;153:1036-41.
31. 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;18:31.
32. Carter YM, Mazeh H, Sippel RS, Chen H. Safety and feasibility of laparoscopic resection for large (‡6 CM) pheochromocytomas without suspected malignancy. Endocr Pract 2012;18:720-6.
33. Chung HS, Kim MS, Yu HS, et al. Laparoscopic adrenalectomy using the lateral retroperitoneal approach: Is it a safe and feasible treatment option for pheochromocytomas larger than 6 cm? Int J Urol 2018;25:414-9.
34. Hwang I, Jung SI, Yu SH, Hwang EC, Yu HS, Kim SO. Is larger tumor size a contraindication to retroperitoneal laparoscopic adrenalectomy? World J Urol 2014;32:723-8.