Department of General, Visceral, Cancer and Transplant Surgery, University Hospital Cologne, Cologne, Germany.
Polyclinic for Endocrinology, Diabetes and Preventive Medicine, University Hospital Cologne, Köln, Germany.
Horm Metab Res. 2023 Nov;55(11):765-770. doi: 10.1055/a-2187-3547. Epub 2023 Oct 30.
COVID-19 has severely affected the delivery of surgical care worldwide. The aim of the present study was to evaluate its impact on adrenal surgery at our academic endocrine center. All primary adrenal surgeries performed at the University Hospital of Cologne, Germany between 01.01.2019 and 31.07.2022 were included. This time frame was divided into pre-Covid (before 02/20), acute Covid (until 05/21), and post acute period (after 05/2021). Demographics, clinic-pathologic characteristics and treatment of these patients were analyzed. One hundred adrenalectomies were included: 22 before, 30 during, and 48 after the acute phase. The percentage of Conn adenomas and pheochromocytomas decreased during the acute phase (from 45.4 to 26.6% and from 18 to 10%, respectively) in favor of Cushing adenomas and suspicious tumors (from 4.5 to 20% and from 31.8 to 36.6%). About 90.9% of tumors resected for suspicion of malignancy were confirmed malignant by final histopathology, as opposed to 71.4% and 52.6% before and after the acute phase. The operative technique was similar during the three phases (63% retroperitoneoscopic, 34% laparoscopic and 2% open resections), with a significantly shorter operative time for retroperitoneoscopy (p=0.04). ICU monitoring demand increased during the acute phase (from 13.6% to 43.3%), according to the increase in Cushing adenomas and malignant tumors. During the acute phase of COVID-19 pandemic adrenal surgery for Cushing and malignant tumors increased, while a delay in pheochromocytoma surgery to the post acute phase was observed. The suspicion of malignancy formulated by the endocrine tumor board was accurate in 90.9% of cases.
COVID-19 已严重影响全球的外科手术。本研究旨在评估其对我院内分泌中心肾上腺手术的影响。纳入德国科隆大学医院 2019 年 1 月 1 日至 2022 年 7 月 31 日进行的所有原发性肾上腺手术。该时间段分为新冠前（2 月 2 日之前）、急性新冠（至 5 月 21 日）和后急性期（5 月 2021 年之后）。分析这些患者的人口统计学、临床病理特征和治疗方法。共纳入 100 例肾上腺切除术：新冠前 22 例，新冠期间 30 例，新冠后 48 例。急性期中，Conn 腺瘤和嗜铬细胞瘤的比例下降（分别从 45.4%降至 26.6%和从 18%降至 10%），而库欣腺瘤和可疑肿瘤的比例上升（分别从 4.5%升至 20%和从 31.8%升至 36.6%）。出于恶性嫌疑而切除的肿瘤中，约 90.9%经最终组织病理学证实为恶性，而新冠前和新冠后分别为 71.4%和 52.6%。三个阶段的手术技术相似（63%腹膜后腹腔镜手术，34%腹腔镜手术和 2%开放手术），腹膜后腹腔镜手术的手术时间明显缩短（p=0.04）。根据库欣腺瘤和恶性肿瘤的增加，急性期中 ICU 监测需求增加（从 13.6%增加至 43.3%）。COVID-19 大流行期间，肾上腺手术治疗库欣病和恶性肿瘤的数量增加，而嗜铬细胞瘤手术则延迟到后急性期。内分泌肿瘤委员会制定的恶性嫌疑准确率为 90.9%。
