Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, St. Louis, MO 63111, USA.
Surg Endosc. 2013 Jul;27(7):2342-50. doi: 10.1007/s00464-013-2789-7. Epub 2013 Feb 13.
Risk factors for selecting patients for open adrenalectomy (OA) and for conversion are limited in most series. This study aimed to investigate variables that are important in selecting patients for OA, predict risk of conversion from laparoscopic adrenalectomy (LA), and impact 30-day outcomes of OA and LA.
A retrospective cohort study of prospectively collected data was conducted. Patients (≥ 16 years old) who underwent adrenalectomy in the Division of General Surgery at Barnes-Jewish Hospital (1993-2010) were grouped by operative approach (LA vs. OA) and compared using nonparametric tests and regression analyses (α < 0.05).
In total, 402 patients underwent 422 adrenalectomies. Compared to LA patients, those in the OA group were older (p = 0.02), had higher ASA scores (p = 0.04), larger tumor size (p < 0.01), and fewer functioning lesions (p < 0.01). OA patients more often required concurrent procedures (p < 0.01), had a longer operative time (p = 0.04), more intraoperative complications (p = 0.02), higher estimated blood loss (EBL), and larger transfusion requirement. Preoperative factors that predicted selection for OA were higher patient age (p = 0.01), higher ASA score (p = 0.03), larger tumor size (p < 0.01), nonfunctioning lesion (p < 0.01), diagnosis of adrenocortical carcinoma (p < 0.01), and the need for concomitant procedures (p < 0.01). Conversion to open or hand-assisted approach occurred in 6.2 % of LA patients. Preoperative risks for conversion included large tumor size (>8 cm) and need for concomitant procedures (p < 0.01). Multivariate analysis revealed that large indeterminate adrenal mass, adrenocortical carcinoma, tumor size (>6 cm), an open operation, conversion, concomitant procedures, operative time >180 min, and EBL >200 mL were predictors of 30-day morbidity.
Adrenal tumor size and need for concurrent procedures significantly impact the selection of patients for OA, the likelihood of conversion, and perioperative morbidity. These metrics should be considered when assessing operative approach and risks for adrenalectomy.
选择开放肾上腺切除术（OA）和中转手术的患者的风险因素在大多数研究中受到限制。本研究旨在探讨选择 OA 患者的重要变量，预测腹腔镜肾上腺切除术（LA）中转的风险，并影响 OA 和 LA 的 30 天结局。
对巴恩斯-犹太医院普外科前瞻性收集的数据进行回顾性队列研究。根据手术方式（LA 与 OA）将患者（≥16 岁）分组，并通过非参数检验和回归分析进行比较（α<0.05）。
共 402 例患者接受了 422 例肾上腺切除术。与 LA 组患者相比，OA 组患者年龄更大（p=0.02），ASA 评分更高（p=0.04），肿瘤更大（p<0.01），功能性病变更少（p<0.01）。OA 组患者更常需要同时进行其他手术（p<0.01），手术时间更长（p=0.04），术中并发症更多（p=0.02），估计出血量更大（EBL），输血需求更高。预测选择 OA 的术前因素包括患者年龄更高（p=0.01），ASA 评分更高（p=0.03），肿瘤更大（p<0.01），无功能性病变（p<0.01），肾上腺皮质癌（p<0.01），以及需要同时进行其他手术（p<0.01）。LA 患者中转开腹或手辅助手术的比例为 6.2%。LA 患者中转的术前危险因素包括肿瘤较大（>8 cm）和需要同时进行其他手术（p<0.01）。多因素分析显示，大的不确定性质肾上腺肿块、肾上腺皮质癌、肿瘤大小（>6 cm）、开放手术、中转手术、同时进行其他手术、手术时间>180 min 和 EBL>200 mL 是 30 天发病率的预测因素。
肾上腺肿瘤大小和同时进行其他手术的需要显著影响 OA 患者的选择、中转的可能性和围手术期发病率。在评估肾上腺切除术的手术方式和风险时，应考虑这些指标。
