Cicek Mehmet Cagatay, Gunseren Kadir Omur, Senol Kazım, Vuruskan Hakan, Yavascaoglu Ismet
Department of Urology, Faculty of Medicine, Uludag University, Bursa, Turkey.
Department of General Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey.
J Laparoendosc Adv Surg Tech A. 2021 Mar;31(3):301-305. doi: 10.1089/lap.2020.0505. Epub 2020 Jul 21.
We aimed to compare the results of patients who underwent laparoscopic adrenalectomy (LA) for masses ≥6 cm versus <6 cm in diameter in our tertiary referral university hospital. Three hundred thirty consecutive patients were divided into two groups according to tumor size (≥6 and <6 cm in diameter). Demographic variables, body mass index (BMI), lesion localization (right/left), tumor diameter, pathological diagnosis and surgical outcomes, including operation time, estimated blood loss (EBL), conversion to open surgery, complications, and length of hospital stay were compared between groups. Between February 2008 and March 2020, 53 patients (29 male-24 female) with ≥6 cm (L group) adrenal tumor and 277 patients (105 male-172 female) with <6 cm tumor (S group) underwent transperitoneal LA. One hundred sixty-eight (50.9%) tumors localized on the left side. In L group mean tumor size in female and male patients was 87.5 ± 40.8 mm (range 50-225 mm) and 67.3 ± 18.4 mm (range 10-100 mm), respectively ( < .05). Age, American Society of Anesthesiology scores, BMI, and mean operation time were similar between groups ( > .05). Postoperative complications were more often in L group ( = .005). EBL in group L and group S was 86 ± 70.4 mL (range 10-500 mL) and 55 ± 44.2 mL (range 10-300 mL), respectively ( = .003). Length of hospital stay in group L and group S was 3.7 ± 3.5 days (range 1-26) and 3 ± 1.6 days (range 1-9), respectively ( = .086). Significant variables in multivariate analysis, including gender (male), EBL, and postoperative complication rate, were entered into multivariate regression analysis, which presented that EBL and postoperative complication rates were independent significants for the L group. Six centimeters should not be considered as an upper limit of transperitoneal lateral LA and may be safely performed in centers with experience. Further studies are needed to confirm our data.
我们旨在比较在我们的三级转诊大学医院中，接受腹腔镜肾上腺切除术（LA）治疗直径≥6 cm与<6 cm肿块的患者的结果。330例连续患者根据肿瘤大小（直径≥6 cm和<6 cm）分为两组。比较两组之间的人口统计学变量、体重指数（BMI）、病变定位（右侧/左侧）、肿瘤直径、病理诊断和手术结果，包括手术时间、估计失血量（EBL）、转为开放手术、并发症和住院时间。在2008年2月至2020年3月期间，53例（29例男性 - 24例女性）肾上腺肿瘤直径≥6 cm（L组）和277例（105例男性 - 172例女性）肿瘤直径<6 cm（S组）的患者接受了经腹LA。168例（50.9%）肿瘤位于左侧。在L组中，女性和男性患者的平均肿瘤大小分别为87.5±40.8 mm（范围50 - 225 mm）和67.3±18.4 mm（范围10 - 100 mm）（<0.05）。两组之间的年龄、美国麻醉医师协会评分、BMI和平均手术时间相似（>0.05）。L组术后并发症更多见（=0.005）。L组和S组的EBL分别为86±70.4 mL（范围10 - 500 mL）和55±44.2 mL（范围10 - 300 mL）（=0.003）。L组和S组的住院时间分别为3.7±3.5天（范围1 - 26天）和3±1.6天（范围1 - 9天）（=0.086）。多因素分析中的显著变量，包括性别（男性）、EBL和术后并发症发生率，被纳入多因素回归分析，结果显示EBL和术后并发症发生率是L组的独立显著因素。6厘米不应被视为经腹侧方LA的上限，在有经验的中心可以安全地进行。需要进一步研究来证实我们的数据。
