University of California San Francisco, Section of Endocrine Surgery, San Francisco, California.
University of California San Francisco, Section of Endocrine Surgery, San Francisco, California.
J Surg Res. 2019 Apr;236:129-133. doi: 10.1016/j.jss.2018.11.031. Epub 2018 Dec 14.
The volume of adrenal surgery is increasing. There has been a concern that the widespread use of axial imaging and minimally invasive approaches has led to changing indications for adrenalectomy. We reviewed trends in adrenal surgery at a single academic institution.
This was a retrospective analysis of all patients who underwent adrenal surgery between 1993 and 2018 by the endocrine surgery service. Patient demographics, diagnosis, operative details, and perioperative complications were evaluated. Trend analysis was performed across ordered year groups (<2000, 2000-2004, 2005-2009, 2010-2014, and 2015-2018).
We identified 732 patients who underwent 751 adrenal operations. Fifty-seven percent of the patients were women, and the median age was 51 y (range: 5-88). There was an increase in the number of procedures performed (P < 0.01, trend analysis). Over time, there was a higher proportion of patients with hypertension (54.7% [<2000] versus 73.6% [>2015], P < 0.01), diabetes (4.7% versus 22.1%, P = 0.01), and classified as American Society of Anesthesiology class 3/4 (15.7% versus 45.7%, P < 0.01). More patients had their adrenal lesion found incidentally (19.4% versus 39.3%, P < 0.01), and there was a larger proportion of pheochromocytomas (25% versus 36.4%, P < 0.01) and fewer nonfunctioning adenomas (7.4% versus 4.3%, P = 0.03). Median tumor size decreased from 3.5 cm to 2.9 cm (P = 0.03). Complication rates increased over time (8.3% versus 15%, P < 0.01), but the overall 30-d mortality remained low (0.3%).
Adrenal surgery is being performed more commonly with an increasing number of incidentalomas and pheochromocytomas. Our patients have higher comorbidities with increase in complication rates over time, although perioperative mortality remains low. This highlights the importance of a thorough preoperative evaluation to identify suitable patients who may benefit from adrenalectomy.
肾上腺手术的数量正在增加。人们担心广泛使用轴向成像和微创手术方法会导致肾上腺切除术的适应证发生变化。我们回顾了一家学术机构的肾上腺手术趋势。
这是对内分泌外科服务在 1993 年至 2018 年间进行的所有肾上腺手术患者的回顾性分析。评估了患者的人口统计学、诊断、手术细节和围手术期并发症。对按序年份组（<2000 年、2000-2004 年、2005-2009 年、2010-2014 年和 2015-2018 年）进行趋势分析。
我们确定了 732 名患者进行了 751 次肾上腺手术。57%的患者为女性，中位年龄为 51 岁（范围：5-88 岁）。手术数量有所增加（P<0.01，趋势分析）。随着时间的推移，高血压患者的比例更高（54.7%[<2000 年]与 73.6%[>2015 年]，P<0.01），糖尿病患者的比例更高（4.7%与 22.1%，P=0.01），美国麻醉师协会（ASA）分类为 3/4 级的患者比例更高（15.7%与 45.7%，P<0.01）。更多患者的肾上腺病变是偶然发现的（19.4%与 39.3%，P<0.01），嗜铬细胞瘤的比例更高（25%与 36.4%，P<0.01），无功能腺瘤的比例更低（7.4%与 4.3%，P=0.03）。肿瘤大小中位数从 3.5 厘米降至 2.9 厘米（P=0.03）。并发症发生率随时间增加（8.3%与 15%，P<0.01），但 30 天死亡率仍较低（0.3%）。
随着偶然发现的肿瘤和嗜铬细胞瘤数量的增加，肾上腺手术的实施越来越普遍。我们的患者合并症更多，随着时间的推移并发症发生率增加，但围手术期死亡率仍然较低。这突出表明术前全面评估的重要性，以确定可能受益于肾上腺切除术的合适患者。
