Department of Urology, Chinese PLA General Hospital/Military Postgraduate Medical School, Beijing 100853, People's Republic of China.
Surg Endosc. 2013 Mar;27(3):992-9. doi: 10.1007/s00464-012-2553-4. Epub 2012 Dec 13.
In a previous experience, anatomical retroperitoneoscopic adrenalectomy (ARA) was proven safe, effective, and technically efficient for surgical adrenal diseases. However, laparoscopic adrenalectomy for adrenal metastasis is controversial. We evaluated the safety, effectiveness, and efficiency of modified ARA technique for adrenal metastasis and predicted survival factors.
From 2000 to 2010, a consecutive series of 75 patients with adrenal metastases underwent 78 ARAs (three bilateral ARAs). Three modifications and one key procedure were specified in this study. Medical records and follow-up data were retrospectively studied. Then, the surgery data of ARA were compared with those of other approaches to evaluate its safety, effectiveness, and efficiency. Additionally, univariate and multivariate analyses were used to predict the risk factors for survival.
The most common primary tumor was renal cell carcinoma (RCC, n = 26), followed by non-small-cell lung carcinoma (NSCLC, n = 23), and hepatocellular carcinoma (HCC, n = 12). A total of 76 successful ARAs and two conversions to open surgery were performed, with a median operation time of 53 (range, 40-250) min and median estimated blood loss of 25 (range, 10-700) mL. The local recurrence rate was 5.3 %, and the median survival was 24 months. These data were comparable with or even better than other approaches in previous studies. The independent prognostic factors of survival were body mass index (BMI, p < 0.001), tumor type (p < 0.001), tumor size (≥ 4 cm vs. <4 cm, p = 0.017), and margin status (negative vs. positive, p = 0.011).
ARA is a safe and effective approach for the management of adrenal metastasis in selected patients. BMI, tumor type, tumor size, and margin status may independently predict survival.
在之前的经验中，解剖式后腹腔镜肾上腺切除术（ARA）已被证明对于手术治疗肾上腺疾病是安全、有效且技术高效的。然而，对于肾上腺转移瘤的腹腔镜肾上腺切除术仍存在争议。我们评估了改良 ARA 技术治疗肾上腺转移瘤的安全性、有效性和效率，并预测了生存因素。
2000 年至 2010 年，连续 75 例肾上腺转移瘤患者接受了 78 例 ARA（3 例双侧 ARA）。本研究中规定了 3 项改良和 1 项关键操作。回顾性研究了病历和随访数据。然后，将 ARA 的手术数据与其他方法进行比较，以评估其安全性、有效性和效率。此外，还使用单变量和多变量分析来预测生存的危险因素。
最常见的原发肿瘤是肾细胞癌（RCC，n=26），其次是非小细胞肺癌（NSCLC，n=23）和肝细胞癌（HCC，n=12）。共成功进行了 76 例 ARA，2 例转为开放手术，中位手术时间为 53（40-250）min，中位估计出血量为 25（10-700）mL。局部复发率为 5.3%，中位生存期为 24 个月。这些数据与之前研究中的其他方法相当甚至更好。生存的独立预后因素包括体重指数（BMI，p<0.001）、肿瘤类型（p<0.001）、肿瘤大小（≥4cm 与<4cm，p=0.017）和切缘状态（阴性与阳性，p=0.011）。
ARA 是治疗选择患者肾上腺转移瘤的一种安全有效的方法。BMI、肿瘤类型、肿瘤大小和切缘状态可能独立预测生存。
