Department of Urology, Apollo Main Hospitals, Chennai, India.
Department of Urology, Amrita Institute of Medical Science, Kochi, India.
Urologia. 2022 Aug;89(3):430-436. doi: 10.1177/03915603221097166. Epub 2022 May 28.
Minimal invasive surgeries (MIS) for large size adrenal tumors are still debatable. The objective is to evaluate the contemporary peri- and post-operative outcomes of patients undergoing (open = OA, laparoscopic = LA, and robotic = RA) adrenalectomies in three institutions.
Retrospectively gathered peri- and post-operative data of 235 patients, underwent adrenalectomy at three Institutions over a 7-year period (2013-2020) were analyzed. All patients underwent thorough radiological and endocrine workup.
Two hundred and thirty five patients who underwent adrenalectomy (OA ( = 29), LA ( = 146), and RA ( = 60)) were assessed. OA ( = 29) versus Minimally invasive surgery ( = 206) showed significant differences (median, value) in larger tumour size, cm (9.4 vs 5, ( = 0.0001)), longer operative time, mins (240 vs 100, ( = 0.0001)), longer hospital stay, days (8 vs 3,( = .0001)), Higher readmission rates (14% vs 1.9%), higher blood loss, ml (400 vs 100, ( = 0.0001)) requiring blood transfusion (14% vs 4.3%) ( = 0.03), higher intraoperative complication (21% vs 6%) ( = 0.0004), and post op complications (17% vs 5.3%) ( = 0.01). Amongst the MIS (RA vs LA), RA appeared be have better outcomes in terms of shorter operative time, less blood loss and less intra operative complications with a value <0.05. These results were consistent for the assessment of patients who had ⩾6 cm tumor size. The postoperative complication rates were lowest with RA (3.3%) compared to OA (17%) and LA (6.1%).
Contemporary practice of adrenalectomy shows that robotic adrenalectomy is safe and effective irrespective of the tumor size.
对于大型肾上腺肿瘤，微创外科手术（MIS）仍存在争议。本研究的目的是评估在三个机构中接受（开放手术=OA、腹腔镜手术=LA 和机器人手术=RA）肾上腺切除术的患者的当代围手术期结局。
回顾性收集了 2013 年至 2020 年期间在三个机构接受肾上腺切除术的 235 例患者的围手术期和术后数据。所有患者均进行了彻底的影像学和内分泌检查。
评估了 235 例接受肾上腺切除术的患者（OA（=29）、LA（=146）和 RA（=60））。OA（=29）与微创手术（=206）相比，肿瘤大小（cm）（中位数， 值）显著更大（9.4 与 5，（=0.0001）），手术时间更长（min）（240 与 100，（=0.0001）），住院时间更长（天）（8 与 3，（=0.0001）），再入院率更高（14%与 1.9%），出血量更多（ml）（400 与 100，（=0.0001））需要输血（14%与 4.3%）（=0.03），术中并发症更高（21%与 6%）（=0.0004），术后并发症更高（17%与 5.3%）（=0.01）。在微创手术（RA 与 LA）中，RA 在手术时间更短、出血量更少、术中并发症更少方面表现出更好的结果， 值<0.05。这些结果对于评估肿瘤大小 ⩾6cm 的患者是一致的。RA 的术后并发症发生率最低（3.3%），低于 OA（17%）和 LA（6.1%）。
当代肾上腺切除术的实践表明，机器人肾上腺切除术是安全有效的，与肿瘤大小无关。
