Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Int J Surg. 2019 Jan;61:26-32. doi: 10.1016/j.ijsu.2018.11.018. Epub 2018 Nov 29.
Surgical resection is the main treatment strategy for pheochromocytoma. Whether laparoscopic techniques are feasible for large pheochromocytoma treatments is controversial. The aim of this study was to evaluate the feasibility and safety of transperitoneal laparoscopic adrenalectomy (LA) compared with open adrenalectomy (OA).
We retrospectively studied 182 patients with radiographic tumor sizes ≥ 6 cm who underwent adrenalectomy at our center between 1 January 2007 and 31 December 2017. After propensity score-matching to balance baseline variables, 82 patients treated with LA and 100 patients treated with OA were grouped into 64 pairs. Patient demographics, and extensive peri-operative and oncologic data were recorded and compared.
In the matched group, the incidence of intra-operative hemodynamic instability, transfusion rate, prolonged hypotension, and cardiovascular morbidity in the LA group were lower than the OA group (25.0% vs. 48.4%, 29.7% vs. 46.9%, 4.7% vs. 23.4%, and 14.1% vs. 37.5%, respectively). The estimated blood loss was less (100 ml vs. 300 ml) and bowel recovery was quicker (1.9 d vs. 2.3 d) in the LA group. The proportion of patients in whom blood pressure returned to normal (P = 0.184), had recurrences (P = 0.197), and survived (P = 0.763) were equivalent. The surgical approach (OA vs. LA) was an independent risk factor for IHD, prolonged hypotension, cardiovascular morbidity, and longer bowel recovery.
This propensity score-matched cohort study showed that LA was feasible, safe, and superior to OA for patients with large pheochromocytoma, meanwhile LA had comparable oncological outcomes compared with OA after a lengthy follow-up.
手术切除是治疗嗜铬细胞瘤的主要策略。腹腔镜技术是否适用于大型嗜铬细胞瘤的治疗存在争议。本研究旨在评估经腹腔腹腔镜肾上腺切除术（LA）与开放肾上腺切除术（OA）的可行性和安全性。
我们回顾性研究了 2007 年 1 月 1 日至 2017 年 12 月 31 日期间在我们中心接受肾上腺切除术的影像学肿瘤大小≥6cm 的 182 例患者。通过倾向评分匹配来平衡基线变量后，将 82 例接受 LA 治疗的患者和 100 例接受 OA 治疗的患者分为 64 对。记录并比较患者的人口统计学资料以及广泛的围手术期和肿瘤学数据。
在匹配组中，LA 组术中血流动力学不稳定、输血率、低血压持续时间和心血管发病率均低于 OA 组（25.0%比 48.4%、29.7%比 46.9%、4.7%比 23.4%和 14.1%比 37.5%）。LA 组的估计出血量较少（100ml 比 300ml），肠道恢复较快（1.9d 比 2.3d）。血压恢复正常（P=0.184）、复发（P=0.197）和存活（P=0.763）的患者比例相当。手术方式（OA 与 LA）是 IHD、低血压持续时间长、心血管发病率高和肠道恢复时间长的独立危险因素。
这项倾向评分匹配的队列研究表明，LA 对于大型嗜铬细胞瘤患者是可行的、安全的，并且优于 OA，同时在长期随访后，LA 的肿瘤学结果与 OA 相当。
