Zhang Liang, Chen Danlei, Pang Yingxian, Guan Xiao, Xu Xiaowen, Wang Cikui, Xiao Qiao, Liu Longfei
Department of Urology, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Asian J Urol. 2022 Jul;9(3):294-300. doi: 10.1016/j.ajur.2022.04.004. Epub 2022 Jun 20.
Clinical practice guidelines recommend open adrenalectomy (OA) for large pheochromocytoma (LPCC) > 6 cm in size. Although laparoscopic adrenalectomy (LA) for the treatment of LPCC has been reported, its role remains unclear. This study aimed to compare the effectiveness of LA and OA, and summary the surgical treatment experience.
Data concerning LPCC, from January 2010 to June 2019 of a single institution, were retrospectively reviewed. Altogether 82 patients with a tumor larger than 6 cm were included (52 patients in LA group and 30 patients in OA group). Groups were balanced by propensity score matching (PSM) into 15 pairs. Patients' demographics, preoperative characteristics, and prognosis were analyzed.
Before PSM, the OA group had larger tumor sizes (median [interquartile range, IQR]: 8.9 [7.3-10.3] 7.2 [6.7-8.0] cm; =0.000) and higher vanillylmandelic acid level (median [IQR]: 114.3 [67.8-326.4] 66.6 [37.8-145.8] μmol/24 h; =0.004) and needed a higher cumulative dose of prazosin (median [IQR]: 83.5 [37.0-154.0] 38.0 [21.0-81.0] mg; =0.028). After PSM, the baseline data showed no significant differences between both groups. The LA group had relatively more stable blood pressure in surgery, with a lower fluctuation of systolic blood pressure (mean±standard deviation [SD]: 70.9±25.1 107.4±46.2 mmHg, =0.012) and a lower percentage of hemodynamic instability (46.7% 86.7%, =0.020). The LA group had shorter postoperative hospital stays (mean±SD: 6.4±2.7 10.1±3.4 days; =0.003) than the OA group. Differences regarding metastasis rate (6.7% 0, =1.000) were not statistically significant between LA and OA groups. The median (IQR) follow-up time of 82 patients was 72.5 (47.0-103.5) months. Binary logistic regression showed that right-side tumors or those >8 cm in size were independent risk factors of OA.
LA is a safe, minimally invasive procedure for LPCC and has relatively better perioperative characteristics in large medical centers. Patients with tumors on the right side or larger than 8 cm are more likely to undergo OA initially.
临床实践指南推荐对直径大于6cm的大嗜铬细胞瘤（LPCC）行开放性肾上腺切除术（OA）。虽然已有关于腹腔镜肾上腺切除术（LA）治疗LPCC的报道，但其作用仍不明确。本研究旨在比较LA和OA的有效性，并总结手术治疗经验。
回顾性分析2010年1月至2019年6月某单一机构中有关LPCC的数据。共纳入82例肿瘤直径大于6cm的患者（LA组52例，OA组30例）。通过倾向评分匹配（PSM）将两组患者均衡匹配为15对。分析患者的人口统计学资料、术前特征及预后情况。
PSM前，OA组肿瘤直径更大（中位数[四分位数间距，IQR]：8.9[7.3 - 10.3]对7.2[6.7 - 8.0]cm；P = 0.000），香草扁桃酸水平更高（中位数[IQR]：114.3[67.8 - 326.4]对66.6[37.8 - 145.8]μmol/24小时；P = 0.004），且需要更高的哌唑嗪累积剂量（中位数[IQR]：83.5[37.0 - 154.0]对38.0[21.0 - 81.0]mg；P = 0.028）。PSM后，两组的基线数据无显著差异。LA组手术过程中血压相对更稳定，收缩压波动更低（均值±标准差[SD]：70.9±25.1对'107.4±46.2mmHg，P = 0.012），血流动力学不稳定的百分比更低（46.7%对86.7%，P = 0.020）。LA组术后住院时间比OA组短（均值±SD：6.4±2.7对10.1±3.4天；P = （此处原文有误，推测应为P = 0.003））。LA组和OA组的转移率差异（6.7%对0，P = 1.000）无统计学意义。82例患者的中位（IQR）随访时间为72.5（47.0 - 103.5）个月。二元逻辑回归显示右侧肿瘤或直径大于8cm的肿瘤是OA的独立危险因素。
LA是治疗LPCC的一种安全且微创的手术方法，在大型医疗中心具有相对更好围手术期特征。右侧肿瘤或直径大于8cm的患者最初更可能接受OA手术。
