Digestive and Endocrine Surgery Department, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France.
University of Bordeaux, INSERM, BPH U1219, F-33000, Bordeaux, France.
Surg Endosc. 2023 Oct;37(10):7573-7581. doi: 10.1007/s00464-023-10148-0. Epub 2023 Jul 13.
Laparoscopic adrenalectomy (LA) is the gold standard for the resection of most adrenal lesions. A precise delineation of factors influencing its outcomes is lacking. The aim of this study was to assess factors associated with intraoperative complications, postoperative complications, and prolonged length of stay (LOS) after LA.
Patients who underwent LA from 1999 to 2021 in a single-academic-institution were included. Patient and disease-specific data, intraoperative complications, postoperative complications according to Dindo-Clavien (DC) scale, and LOS were recorded. Predictive factors of complications and prolonged LOS were determined by logistic regression.
We identified 530 patients who underwent 547 LA. Intraoperative complications occurred in 33 patients (6.0%). Postoperative complications ≥ DC grade 2 occurred in 73 patients (13.35%); severe postoperative complications ≥ DC grade 3 in 14 patients (2.56%). Postoperative complications were positively associated with age ≥ 72 (OR 1.14 [95% CI 1.02-1.29]), intraoperative complications (OR 1.36 [95% CI 1.14-1.63]), and negatively associated with non functional adenomas (OR 0.88 [95% CI 0.7-0.99]), and right adrenalectomy (OR 0.91 [95% CI 0.86-0.97]). Severe postoperative complications were positively associated with chronic obstructive pulmonary disease (COPD, OR 1.08 [95% CI 1.00-1.17]), and negatively associated with right adrenalectomy (OR 0.97 [95% CI 0.92-0.99]). Prolonged LOS was associated with age ≥ 72 (OR 1.21 [95% CI 1.05-1.41]), and COPD (OR 1.20 [95% CI 1.01-1.44]).
LA remains safe when performed by surgeons with expertise. Right adrenalectomy resulted in less postoperative overall and severe complications. The risk-benefit equation should be carefully assessed before left LA in older patients with COPD.
腹腔镜肾上腺切除术（LA）是大多数肾上腺病变切除的金标准。缺乏对影响其结果的因素的准确描述。本研究旨在评估与 LA 术中并发症、术后并发症和延长住院时间（LOS）相关的因素。
纳入 1999 年至 2021 年在单一学术机构接受 LA 的患者。记录患者和疾病特异性数据、术中并发症、根据 Dindo-Clavien（DC）分级的术后并发症以及 LOS。通过逻辑回归确定并发症和延长 LOS 的预测因素。
我们确定了 530 例接受 547 例 LA 的患者。33 例（6.0%）发生术中并发症。73 例（13.35%）发生≥DC 分级 2 的术后并发症；14 例（2.56%）发生严重术后并发症≥DC 分级 3。术后并发症与年龄≥72 岁（OR 1.14 [95%CI 1.02-1.29]）、术中并发症（OR 1.36 [95%CI 1.14-1.63]）呈正相关，与无功能腺瘤（OR 0.88 [95%CI 0.7-0.99]）和右肾上腺切除术（OR 0.91 [95%CI 0.86-0.97]）呈负相关。严重术后并发症与慢性阻塞性肺疾病（COPD，OR 1.08 [95%CI 1.00-1.17]）呈正相关，与右肾上腺切除术（OR 0.97 [95%CI 0.92-0.99]）呈负相关。延长 LOS 与年龄≥72 岁（OR 1.21 [95%CI 1.05-1.41]）和 COPD（OR 1.20 [95%CI 1.01-1.44]）相关。
由经验丰富的外科医生进行 LA 仍然是安全的。右肾上腺切除术可减少术后总体和严重并发症。在 COPD 老年患者中进行左侧 LA 前，应仔细评估风险效益比。
