Marcadis Andrea R, Rubio Gustavo A, Khan Zahra F, Farra Josefina C, Lew John I
Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M Miller School of Medicine, University of Miami, Miami, Florida.
Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M Miller School of Medicine, University of Miami, Miami, Florida.
J Surg Res. 2017 Nov;219:259-265. doi: 10.1016/j.jss.2017.05.116. Epub 2017 Jul 6.
Both functional (hormone hypersecreting) and nonfunctional (nonhypersecreting) adrenal tumors can have benign or malignant pathology. This study compares perioperative in-hospital outcomes after adrenalectomy in patients with benign versus malignant nonfunctional primary adrenal tumors.
A retrospective cross-sectional analysis was performed using the Nationwide Inpatient Sample database (2006-2011) to identify patients who underwent unilateral open or laparoscopic adrenalectomy for nonfunctional primary adrenal tumors. Patients were subdivided by benign and malignant final pathology. Demographics, comorbidities, and perioperative complications were compared between groups using bivariate and multivariate logistic regression.
Of 23,297 patients, 89.7% (n = 20,897) had benign tumors, whereas 10.3% (n = 2400) had malignant tumors. Those with malignant tumors had higher Charlson Comorbidity Index scores and were more likely to undergo adrenalectomy at high volume centers. For both laparoscopic and open approach, patients with malignant nonfunctional tumors had higher rates of intraoperative complications including vascular and splenic injury (P < 0.01), as well as postoperative complications including hematoma, shock, acute kidney injury, venous thromboembolism, and pneumothorax (P < 0.01). In addition, the malignant group had higher rates of blood transfusions, longer hospital stay, and higher in-hospital mortality (P < 0.05) than benign counterparts. On risk-adjusted multivariate analysis, malignant nonfunctional primary adrenal tumors were independently associated with increased risk of complications following adrenalectomy.
Patients with malignant nonfunctional primary adrenal tumors have higher perioperative morbidity and mortality compared to patients with benign nonfunctional adrenal tumors. Such patients should be medically optimized before adrenalectomy, and surgeons must remain vigilant in preventing perioperative complications.
功能性（激素分泌过多）和非功能性（非分泌过多）肾上腺肿瘤均可有良性或恶性病理表现。本研究比较了良性与恶性非功能性原发性肾上腺肿瘤患者肾上腺切除术后的围手术期院内结局。
利用全国住院患者样本数据库（2006 - 2011年）进行回顾性横断面分析，以确定因非功能性原发性肾上腺肿瘤接受单侧开放或腹腔镜肾上腺切除术的患者。患者根据最终病理结果分为良性和恶性两组。使用双变量和多变量逻辑回归比较两组患者的人口统计学、合并症和围手术期并发症。
在23297例患者中，89.7%（n = 20897）为良性肿瘤，而10.3%（n = 2400）为恶性肿瘤。恶性肿瘤患者的查尔森合并症指数得分更高，且更有可能在大容量中心接受肾上腺切除术。对于腹腔镜和开放手术入路，恶性非功能性肿瘤患者术中并发症发生率更高，包括血管和脾脏损伤（P < 0.01），以及术后并发症，包括血肿、休克、急性肾损伤、静脉血栓栓塞和气胸（P < 0.01）。此外，恶性组输血率更高、住院时间更长、院内死亡率更高（P < 0.05），高于良性组。在风险调整的多变量分析中，恶性非功能性原发性肾上腺肿瘤与肾上腺切除术后并发症风险增加独立相关。
与良性非功能性肾上腺肿瘤患者相比，恶性非功能性原发性肾上腺肿瘤患者围手术期发病率和死亡率更高。此类患者在肾上腺切除术前应进行医学优化，外科医生必须保持警惕以预防围手术期并发症。
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