Parente Alessandro, Verhoeff Kevin, Wang Yanbo, Wang Nanya, Wang Zhicheng, Śledziński Maciej, Hellmann Andrzej, Raffaelli Marco, Pennestrì Francesco, Sywak Mark, Papachristos Alexander J, Palazzo Fausto F, Sung Tae-Yon, Kim Byung-Chang, Lee Yu-Mi, Eatock Fiona, Anderson Hannah, Iacobone Maurizio, Daukša Albertas, Makay Ozer, Turk Yigit, Basut Atalay Hafize, Nieveen van Dijkum Els J M, Engelsman Anton F, Holscher Isabelle, Materazzi Gabriele, Rossi Leonardo, Becucci Chiara, Shore Susannah L, Fung Clare, Waghorn Alison, Mihai Radu, Balasubramanian Sabapathy P, Pannu Arslan, Tatarano Shuichi, Velázquez-Fernández David, Miller Julie A, Serrao-Brown Hazel, Chen Yufei, Demarchi Marco Stefano, Djafarrian Reza, Doran Helen, Wang Kelvin, Stechman Michael J, Perry Helen, Hubbard Johnathan, Lamas Cristina, Mercer Philippa, MacPherson Janet, Lumbiganon Supanut, Calatayud María, Alexandra Hanzu Felicia, Vidal Oscar, Araujo-Castro Marta, Minguez Ojeda Cesar, Papavramidis Theodosios, Rodríguez de Vera Gómez Pablo, Aldrees Abdulaziz, Altwjry Tariq, Valdés Nuria, Álvarez-Escola Cristina, García Sanz Iñigo, Blanco Carrera Concepción, Manjón-Miguélez Laura, De Miguel Novoa Paz, Recasens Mónica, García Centeno Rogelio, Robles Lázaro Cristina, Van Den Heede Klaas, Van Slycke Sam, Michalopoulou Theodora, Aspinall Sebastian, Melvin Ross, Lau Joel Wen Liang, Cheah Wei Keat, Tang Man Hon, Oh Han Boon, Ayuk John, Sutcliffe Robert P
Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK; Department of Hepatopancreatobiliary and Liver Transplant Surgery, Queen Elizabeth Hospital, Birmingham, UK; Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alberta, Canada.
Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alberta, Canada.
Eur Urol Focus. 2025 Jan;11(1):118-125. doi: 10.1016/j.euf.2024.09.001. Epub 2024 Sep 14.
Robotic adrenalectomy (RA) has attracted interest as an alternative to laparoscopic adrenalectomy (LA) for patients with pheochromocytoma, although its beneficial effects are uncertain. Our aim was to compare RA and LA outcomes for these patients.
Data for patients who underwent RA or LA for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed. We analyzed baseline characteristics and postoperative complications at discharge, 90 d, and 1 yr. We conducted propensity score matching (PSM; 1:1 ratio) and multivariable analyses to evaluate outcomes and risk factors for the occurrence of complications and higher Comprehensive Complication Index (CCI).
Of 1755 patients, 1613 (91.9%) underwent LA and 142 (8.1%) underwent RA. Estimated blood loss, conversion rate, complication rate, and CCI at discharge, 90 d, and 1 yr were similar between the groups. However, RA was associated with a longer operative time in comparison to LA (100 vs 123 min; p < 0.001), but not after PSM (p = 0.120). Multivariable analysis revealed that Charlson comorbidity index (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.07-1.29; p = 0.001), and tumor size per 1-cm increment (OR 1.13, 95% CI 1.07-1.21; p < 0.001) were independently associated with the incidence of complications, but there was no significant difference in complication rates between the LA and RA groups (OR 1.09, 95% CI 0.63-1.87; p = 0.767). After PSM, RA was associated with a lower rate of severe (grade ≥3a) complications in comparison to LA (p = 0.023).
RA is a safe alternative to LA and yields similar outcomes for patients with pheochromocytoma. RA may be associated with a lower likelihood of severe complications. Further studies are warranted to determine the role of robotic surgery in pheochromocytoma.
Pheochromocytoma is a rare tumor in the adrenal gland and the gold-standard treatment is surgical removal. We assessed patient outcomes after robot-assisted surgery compared with laparoscopic surgery and found that outcomes are similar, but the rate of severe complications may be lower if a surgical robot is used.
机器人肾上腺切除术（RA）作为嗜铬细胞瘤患者腹腔镜肾上腺切除术（LA）的替代方案引起了关注，尽管其有益效果尚不确定。我们的目的是比较这些患者的RA和LA手术结果。
回顾了2012年至2022年期间在46个国际中心接受RA或LA治疗嗜铬细胞瘤患者的数据。我们分析了出院时、90天和1年时的基线特征和术后并发症。我们进行了倾向评分匹配（PSM；1:1比例）和多变量分析，以评估并发症发生情况和较高综合并发症指数（CCI）的结果及危险因素。
1755例患者中，1613例（91.9%）接受了LA，142例（8.1%）接受了RA。两组在出院时、90天和1年时的估计失血量、中转率、并发症发生率和CCI相似。然而，与LA相比，RA的手术时间更长（100分钟对123分钟；p < 0.001），但PSM后无差异（p = 0.120）。多变量分析显示，Charlson合并症指数（比值比[OR] 1.17，95%置信区间[CI] 1.07 - 1.29；p = 0.001）以及肿瘤大小每增加1厘米（OR 1.13，95% CI 1.07 - 1.21；p < 0.001）与并发症发生率独立相关，但LA组和RA组的并发症发生率无显著差异（OR 1.09，95% CI 0.63 - 1.87；p = 0.767）。PSM后，与LA相比，RA的严重（≥3a级）并发症发生率较低（p = 0.023）。
RA是LA的一种安全替代方案，对于嗜铬细胞瘤患者产生相似的结果。RA可能与严重并发症的可能性较低相关。有必要进一步研究以确定机器人手术在嗜铬细胞瘤中的作用。
嗜铬细胞瘤是肾上腺的一种罕见肿瘤，金标准治疗方法是手术切除。我们评估了机器人辅助手术与腹腔镜手术相比的患者结果，发现结果相似，但使用手术机器人时严重并发症的发生率可能较低。
