Sun Fukang, Zhuo Ran, Ma Wenming, He Hongchao, Ye Lei, Xu Danfeng, Wang Weiqing, Ning Guang
Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Health Ministry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Surg Oncol. 2019 May;119(6):801-806. doi: 10.1002/jso.25364. Epub 2019 Jan 30.
To clarify the correlation of variant venous anatomy with adrenal tumor phenotype and surgical outcomes.
This retrospective study included 303 consecutive minimally invasive adrenalectomies from 301 patients. All adrenal veins were identified. We compared the preoperative, intraoperative, and postoperative data between patients with and without variant adrenal venous anatomy. We also explored the factors associated with venous variants.
We found variant venous anatomy in 62 of 303 adrenalectomies (20.5%). Compared with patients with normal anatomy, those with variant anatomy were associated with larger tumor size, larger adrenal veins, more adrenal medullary tumors, longer operation time, more estimated intraoperative blood loss, longer length of hospitalization, and more transfusion. Computed tomography (CT) images may improve the identification of venous anatomy. Tumor size and diagnosis of pheochromocytoma were independently related to variant venous anatomy, whereas sex, tumor size, and venous variant influenced hemorrhage. For pheochromocytoma with variant venous anatomy operated on by a single surgeon, robot-assisted laparoscopic adrenalectomy was associated with shorter postoperative hospitalization.
Adrenal vein variants are associated with worse outcomes in adrenal tumors and an optimized surgery strategy should be applied to this group of patients.
明确变异静脉解剖结构与肾上腺肿瘤表型及手术结局的相关性。
本回顾性研究纳入了301例患者连续进行的303例微创肾上腺切除术。识别所有肾上腺静脉。我们比较了有和没有变异肾上腺静脉解剖结构的患者术前、术中和术后的数据。我们还探讨了与静脉变异相关的因素。
我们在303例肾上腺切除术中发现62例存在变异静脉解剖结构（20.5%）。与解剖结构正常的患者相比，存在变异结构的患者肿瘤更大、肾上腺静脉更粗、肾上腺髓质肿瘤更多、手术时间更长、估计术中失血量更多、住院时间更长且输血更多。计算机断层扫描（CT）图像可能有助于提高静脉解剖结构的识别。肿瘤大小和嗜铬细胞瘤的诊断与变异静脉解剖结构独立相关，而性别、肿瘤大小和静脉变异影响出血情况。对于由单一外科医生进行手术的具有变异静脉解剖结构的嗜铬细胞瘤，机器人辅助腹腔镜肾上腺切除术与术后住院时间较短相关。
肾上腺静脉变异与肾上腺肿瘤的较差结局相关，应针对这组患者应用优化的手术策略。
