Tsai I-Chen, Hsieh Yu-Che, Tseng Wen-Hsin, Liu Chien-Liang, Ho Chung-Han, Li Chien-Feng, Chiu Allen W, Huang Steven K
Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
The Doctoral Program of Clinical and Experimental Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.
Front Surg. 2024 Jan 5;10:1284093. doi: 10.3389/fsurg.2023.1284093. eCollection 2023.
Adrenal tumors are relatively common, and adrenalectomy is the third most common endocrine surgery. Patients with adrenal tumors were categorized into two groups for analysis: those with intermediate (4-6 cm, Group 1) and large (>6 cm, Group 2) tumors undergoing Retroperitoneal Laparoscopic Adrenalectomy (RLA). The primary outcome is to compare the surgical outcomes between these two groups. The secondary outcome involves analyzing the relationship between tumor characteristics and the incidence of adverse events.
Data from 76 patients who underwent RLA for tumors of size ≥4 cm between 2005 and 2022 at a single tertiary referral center were analyzed retrospectively. Variables, including patients' age, hormone function, operation time, conversion to open approach, perioperative complications, and adverse surgical events (blood loss >500 cc, conversion to open approach, and perioperative complications), were assessed.
No significant differences were observed between the two groups in terms of functional and histopathologic analysis, gender distribution, functioning factors, perioperative complications, and estimated blood loss. However, patients in Group 2 were younger (median age 50, IQR: 40-57, = 0.04), experienced longer operative times (median 175 min, IQR: 145-230 min, = 0.005), and had a higher rate of conversion to open surgery (12%, = 0.033). For every 1 cm increase in tumor size, the odds ratio for adverse surgical events increased by 1.58.
RLA is a safe and feasible procedure for adrenal tumors larger than 6 cm. While intraoperative and postoperative complications are not significantly increased in either group, larger tumors increase surgery times and are more likely to require conversion to open surgery. Therefore, caution and preparedness for potential adverse events are recommended when dealing with larger tumors. A tumor size of 5.3 cm may serve as a guide for risk stratification and surgical planning in large adrenal tumor management.
肾上腺肿瘤相对常见，肾上腺切除术是第三常见的内分泌手术。肾上腺肿瘤患者被分为两组进行分析：肿瘤大小为中等（4 - 6厘米，第1组）和较大（>6厘米，第2组）且接受腹膜后腹腔镜肾上腺切除术（RLA）的患者。主要结局是比较这两组的手术结果。次要结局包括分析肿瘤特征与不良事件发生率之间的关系。
回顾性分析了2005年至2022年期间在一家单一的三级转诊中心接受RLA治疗肿瘤大小≥4厘米的76例患者的数据。评估了包括患者年龄、激素功能、手术时间、转为开放手术、围手术期并发症以及不良手术事件（失血>500 cc、转为开放手术和围手术期并发症）等变量。
两组在功能和组织病理学分析、性别分布、功能因素、围手术期并发症和估计失血量方面未观察到显著差异。然而，第2组患者更年轻（中位年龄50岁，IQR：40 - 57岁，P = 0.04），手术时间更长（中位175分钟，IQR：145 - 230分钟，P = 0.005），转为开放手术的比例更高（12%，P = 0.033）。肿瘤大小每增加1厘米，不良手术事件的比值比增加1.58。
RLA对于大于6厘米的肾上腺肿瘤是一种安全可行的手术。虽然两组的术中及术后并发症均未显著增加，但较大的肿瘤会增加手术时间，且更有可能需要转为开放手术。因此，在处理较大肿瘤时，建议对潜在不良事件保持谨慎并做好准备。肿瘤大小5.3厘米可作为大肾上腺肿瘤管理中风险分层和手术规划的指导。
