Prognostic indices of perioperative outcome following transperitoneal laparoscopic adrenalectomy

Journal of Laparoendoscopic & Advanced Surgical Techniques (Impact Factor: 1.34). 08/2014; 24(8):528-33. DOI: 10.1089/lap.2014.0048
Source: PubMed


We sought to identify preoperative patient and tumor characteristics that may be useful prognostic indicators of postsurgical outcome in patients undergoing laparoscopic adrenalectomy (LA).

Subjects and methods:
Data from 92 patients who underwent 93 transabdominal LA procedures between 2006-2012 were retrieved. Patients were stratified based on estimated blood loss (EBL), length of stay (LOS), and perioperative complications. Interdependencies between surgical outcome and patient demographics, tumor characteristics, comorbidities, and Charlson Comorbidity Index (CCI) were statistically analyzed. The predictive capacity of each index was assessed using receiver operating characteristic curves.

Neither age, gender, tumor laterality, body mass index, American Society of Anesthesiologists (ASA) score, nor CCI predicted the occurrence of perioperative complications. EBL was significantly associated with increased age, tumor size, ASA score, and CCI, whereas prolonged LOS was associated with higher ASA score. Tumor size was related, although not significantly, to LOS and perioperative complications. Tumors ≥7.5 cm in diameter were significantly associated with worse perioperative outcomes.

LA for adrenal lesions demonstrated reasonable complication rates and perioperative outcomes. Tumor size, CCI, and ASA score are predictive of increased EBL and LOS.

4 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The current literature suggests that minimally invasive distal pancreatectomy (MIDP) is associated with faster recovery and less morbidity than open surgery. However, most studies have been limited by a small sample size and a single-institution design. To overcome this problem, the first metaanalysis of studies comparing MIDP and open distal pancreatectomy (ODP) has been performed. A systematic literature review was conducted to identify studies comparing MIDP and ODP. Perioperative outcomes (e.g., morbidity and mortality, pancreatic fistula rates, blood loss) constituted the study end points. Metaanalyses were performed using a random-effects model. For the metaanalysis, 10 studies including 349 patients undergoing MIDP and 380 patients undergoing ODP were considered suitable. The patients in the two groups were similar with respect to age, body mass index (BMI), American Society of Anesthesiology (ASA) classification, and indication for surgery. The rate of conversion from full laparoscopy to hand-assisted procedure was 37%, and that from minimally invasive to open procedure was 11%. Patients undergoing MIDP had less blood loss, a shorter time to oral intake, and a shorter postoperative hospital stay. The mortality and reoperative rates did not differ between MIDP and ODP. The MIDP approach had fewer overall complications [odds ratio (OR), 0.49; 95% confidence interval (CI), 0.27-0.89], major complications (OR, 0.57; 95% CI, 0.34-0.96), surgical-site infections (OR, 0.32; 95% CI, 0.19-0.53), and pancreatic fistulas (OR, 0.68; 95% CI, 0.47-0.98). The MIDP procedure is feasible, safe, and associated with less blood loss and overall complications, shorter time to oral intake, and shorter postoperative hospital stay. Furthermore, the minimally invasive approach reduces the rate of pancreatic leaks and surgical-site infections after ODP.
    Surgical Endoscopy 12/2010; 25(5):1642-51. DOI:10.1007/s00464-010-1456-5 · 3.26 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Laparoscopic adrenalectomy (LA) is a safe minimally invasive approach for treatment of pheochromocytoma (PHEO). Posterior retroperitoneoscopic adrenalectomy (PRA) is an alternative minimally invasive technique; however, there is a lack of data regarding the appropriateness of this approach in patients with PHEO. Our endocrine surgery database was queried to identify patients who underwent LA or PRA for PHEO. Patient and tumor characteristics, as well as operative details and postoperative course were compared between the 2 groups. LA or PRA was attempted in 46 patients with PHEO (23 LA, 23 PRA). There were no differences in age, BMI, or tumor size between these groups. PRA was associated with significantly reduced operative times (99 min vs 145 min, P < .001), estimated blood loss (8.4 cc vs 123.8 cc, P = .02), and postoperative length of stay (1.9 nights vs 3.1 nights, P < .01). There was no significant difference in rates of conversion to an open procedure or perioperative complications between these groups. LA and PRA are both safe and effective approaches in patients with PHEO. In our experience, PRA results in decreased operative times, blood loss, and postoperative length of stay compared with LA. PRA has become our preferred approach for patients with PHEO.
    Surgery 09/2011; 150(3):452-8. DOI:10.1016/j.surg.2011.07.004 · 3.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Open adrenalectomy has been the gold-standard therapy for adrenal neoplasms. Minimally invasive treatments, however, have assumed a more central role in the management of these lesions. The traditional benefits of laparoscopy, including reduced blood loss, shorter hospital duration, and improved convalescence, extend to adrenal disease without compromising the oncologic efficacy of the surgery. Contemporary series suggest that minimally invasive surgery is also a reasonable therapeutic modality for larger adrenal masses. Laparoscopic adrenalectomy for these large masses is a technically demanding procedure that should be undertaken by experienced laparoscopic surgeons familiar with retroperitoneal anatomy and adept with vascular techniques in the event of an open conversion. Oncologic outcomes collectively suggest that in the setting of adequate surgical resection, recurrence patterns relate more to disease-process biology than surgical approach. Neither size criteria, suspicion of malignancy, nor locally invasive disease should be considered an absolute contraindication to laparoscopic adrenalectomy.
    Current Urology Reports 02/2008; 9(1):73-9. DOI:10.1007/s11934-008-0014-3 · 1.51 Impact Factor
Show more