Hla Diana A, Celik Nafiye Busra, Elli Enrique F
Mayo Clinic Alix School of Medicine, Jacksonville, FL, USA.
Department of General Surgery, Mayo Clinic, Jacksonville, FL, USA.
Surg Open Sci. 2024 Jul 3;20:230-235. doi: 10.1016/j.sopen.2024.07.001. eCollection 2024 Aug.
Partial adrenalectomy (PA) is increasingly used to treat benign tumors to lower the probability of adrenal insufficiency and reduce need for lifetime hormone replacement therapy. Currently, two major concerns are increased bleeding and non-functioning adrenal remnants. This paper examines these concerns and compares surgical approaches with novel findings.
Between 1993 and 2023, 72 patients underwent PA for primary adrenal disorders. Demographic, clinicopathologic and outcome data were analyzed for summary statistics, confidence intervals, and heteroscedastic -test statistics.
The patients were 17-76 years-old and were 59.7 % female. The PA was on the left 54.2 % and bilaterally 4.2 %. The indications were adrenal adenoma, pheochromocytoma, cyst, hyperplasia, and other. The mean tumor diameter was 2.7 cm (range 0.7-10 cm). 23 were performed open, 43 laparoscopically, and 6 with an intended robotic approach. Median follow-up was 9.3 years.Robotic had the shortest length of stay (LOS) (-value 0.01), then laparoscopic (p-value 0.00004), then open. The estimated blood loss (EBL) ranged from 5 to 500 mL (median 50 mL). The median LOS was two days.Intra-operative complication rate was 1.4 % and readmission within 30 days occurred in 2.8 %. Out of 72 patients, 6.8 % needed hormone replacement; of the 14 patients with contralateral adrenalectomy, 28.6 % needed replacement.
PA appears to be safe with both laparoscopic and robotic-assisted techniques with superior perioperative outcomes. The functional results of PA prevent most patients from requiring ongoing steroid replacement treatment and recurrence rates were low. PA should be advised for more frequent use as the preferred treatment method of choice.
Partial adrenalectomies' perioperative and long-term outcomes over a median 9.3 year follow-up emphasized its safety and efficacy with 95 % CI of (2.7 cm, 3.6 cm) for masses with adrenal sufficiency post-resection. Additionally, as healthcare institutions decide whether to invest in surgical robots, robotic approach's outperformance of laparoscopic and open on LOS may be counterbalanced by laparoscopic's strong performance in low EBL.
肾上腺部分切除术（PA）越来越多地用于治疗良性肿瘤，以降低肾上腺功能不全的概率，并减少终身激素替代治疗的需求。目前，两个主要问题是出血增加和肾上腺残余组织无功能。本文探讨了这些问题，并将手术方法与新发现进行了比较。
1993年至2023年期间，72例患者因原发性肾上腺疾病接受了PA手术。对人口统计学、临床病理和结局数据进行分析，以得出汇总统计数据、置信区间和异方差检验统计数据。
患者年龄在17至76岁之间，女性占59.7%。PA手术左侧占54.2%，双侧占4.2%。手术适应症为肾上腺腺瘤、嗜铬细胞瘤、囊肿、增生及其他。肿瘤平均直径为2.7cm（范围0.7至10cm）。23例采用开放手术，43例采用腹腔镜手术，6例计划采用机器人手术。中位随访时间为9.3年。机器人手术的住院时间最短（-值0.01），其次是腹腔镜手术（p值0.00004），然后是开放手术。估计失血量（EBL）在5至500mL之间（中位值50mL）。中位住院时间为两天。术中并发症发生率为1.4%，30天内再入院率为2.8%。72例患者中，6.8%需要激素替代治疗；在14例接受对侧肾上腺切除术的患者中，28.6%需要替代治疗。
PA在腹腔镜和机器人辅助技术下似乎都是安全的，围手术期结局更佳。PA的功能结果使大多数患者无需持续的类固醇替代治疗，且复发率较低。应建议更频繁地使用PA作为首选治疗方法。
在中位9.3年的随访中，肾上腺部分切除术的围手术期和长期结局强调了其安全性和有效性，切除术后肾上腺功能充足的肿块的95%置信区间为（2.7cm，3.6cm）。此外，随着医疗机构决定是否投资手术机器人，机器人手术在住院时间方面优于腹腔镜手术和开放手术的优势可能会被腹腔镜手术在低失血量方面的出色表现所抵消。
