Aydin Husnu, Dural Ahmet Cem, Sahbaz Nuri Alper, Bulut Sezer, Guzey Deniz, Akarsu Cevher, Bozkur Evin, Karabulut Mehmet
Department of General Surgery, Bakırkoy Dr Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
Department of Endocrinology, Bakırkoy Dr Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
Sisli Etfal Hastan Tip Bul. 2021 Sep 24;55(3):325-332. doi: 10.14744/SEMB.2021.13845. eCollection 2021.
The aim of this study is to compare the intraoperative and short-term outcomes of different surgical approaches for hormone active and non-functional adrenal masses.
The data of 206 patients who underwent adrenal gland surgery in our clinic between 2012 and 2020 were retrospectively analyzed. Pre-operative outpatient clinic records of the patients, imaging methods, laboratory results and surgery records, operation time (OT), amount of bleeding, duration of hospital stay, and complications were evaluated. Patients were divided into two groups as those with non-functional mass (=80) and those with hormoneactive mass (=126).
The median age of the patients was 52 (range 19-83) and 77.2% of them were female. Tumor size was larger in hormone active group (=0.311), and the difference was more pronounced in the pheochromocytoma subgroup (=0.088). The rate of transition to open surgery was similar in both groups (0.959), and no conversion to laparoscopy or conventional open surgery was performed in robotic cases. The duration of surgery (=0.669), mean amount of blood loss (=0.834), and mean hospital stay (=0.195) were also similar between the two groups. Intraoperative and post-operative complications were similar between two groups (=0.573 and =0.415, respectively). Considering the subgroup analysis of the patients in hormone active group; the duration of hospital stay was longer in patients with Cushing syndrome (=0.001), while there was no difference in OT and estimated blood loss between patients who were operated for Conn, Cushing, and pheochromocytoma (=0.086 and =0.099; respectively).
Surgical results of hormone active adrenal masses were found to be similar to non-functional masses. Although the hormonal condition of the mass does not change the difficulty level of the surgical procedure, it may be recommended that the robotic approach be preferred to facilitate manipulation in these masses.
本研究旨在比较激素活性肾上腺肿块和无功能肾上腺肿块不同手术方式的术中及短期疗效。
回顾性分析2012年至2020年间在我院接受肾上腺手术的206例患者的数据。评估患者术前门诊记录、影像学检查方法、实验室检查结果及手术记录、手术时间（OT）、出血量、住院时间及并发症情况。患者分为无功能肿块组（=80例）和激素活性肿块组（=126例）。
患者中位年龄为52岁（范围19 - 83岁），其中77.2%为女性。激素活性组肿瘤大小更大（=0.311），在嗜铬细胞瘤亚组中差异更明显（=0.088）。两组中转开腹手术的比例相似（0.959），机器人手术病例中未转为腹腔镜手术或传统开腹手术。两组手术时间（=0.669）、平均出血量（=0.834）及平均住院时间（=0.195）也相似。两组术中及术后并发症相似（分别为=0.573和=0.415）。考虑激素活性组患者的亚组分析；库欣综合征患者住院时间更长（=0.001），而原发性醛固酮增多症、库欣综合征和嗜铬细胞瘤患者的手术时间和估计出血量无差异（分别为=0.086和=0.099）。
发现激素活性肾上腺肿块的手术结果与无功能肿块相似。虽然肿块的激素状态不会改变手术操作的难度，但可能建议优先选择机器人手术方式以利于处理这些肿块。
