嗜铬细胞瘤肾上腺切除术肥胖患者的结局：一项国际多中心分析。
Outcomes for Patients with Obesity Undergoing Adrenalectomy for Pheochromocytoma: An International Multicenter Analysis.
作者信息
Verhoeff Kevin, Parente Alessandro, 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, Atalay Hafize Basut, van Dijkum Els J M Nieveen, 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, Hanzu Felicia Alexandra, Vidal Oscar, Araujo-Castro Marta, Ojeda Cesar Minguez, Papavramidis Theodosios, de Vera Gómez Pablo Rodríguez, 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
机构信息
Department of Surgery, Division of General Surgery, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB, Canada.
Department of Hepatopancreatobiliary and Liver Transplant Surgery, Queen Elizabeth Hospital, Birmingham, UK.
出版信息
Ann Surg Oncol. 2025 Mar;32(3):1709-1720. doi: 10.1245/s10434-024-16591-0. Epub 2024 Dec 4.
OBJECTIVE
The impact of obesity on outcomes after adrenalectomy for pheochromocytoma is unclear. This study aims to evaluate outcomes after minimally invasive and open adrenalectomy for pheochromocytoma in patients with obesity and to determine factors that may affect outcomes. Patients undergoing adrenalectomy for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed, analyzing baseline information, length of hospital stay (LOS), and postoperative complications.
PATIENTS AND METHODS
Obese (body mass index (BMI) ≥ 30 kg/m) and nonobese patients were compared. Multivariable analysis was utilized to evaluate outcomes and risk factors for complications, LOS, and increased comprehensive complication index (CCI).
RESULTS
Of the 2016 patients, 639 (31.7%) had obesity. Operative time (110.0 versus 105.0 min; p = 0.467), conversion to open rate (3.1% versus 4.7%; p = 0.079), estimated blood loss (20.0 versus 20.0 ml, p = 0.088), rate of complications (19.3% versus 20.8%; p = 0.425), and CCI were similar. However, patients with obesity required a median of 1 day longer LOS (4.0 days versus 5.0 days; p < 0.001). On multivariable analysis, obesity was not significantly associated with complications or higher CCI. Analyzing solely obese patients, laparoscopic (OR 0.24; p < 0.001) and robotic (OR 0.22; p = 0.011) approaches were independently associated with less morbidity. Additionally, multivariable modeling demonstrated that a retroperitoneal approach in patients with BMI ≥ 30 kg/m was independently associated with reduced CCI (- 3.74; p = 0.017). Similar results were demonstrated when analyzing severe obesity (BMI ≥ 35).
CONCLUSIONS
Obesity does not increase complications or CCI following pheochromocytoma resection, but it does increase LOS. A retroperitoneal approach may uniquely benefit patients with obesity. In view of rising obesity rates, these results warrant further research to validate findings.
目的
肥胖对嗜铬细胞瘤肾上腺切除术后结局的影响尚不清楚。本研究旨在评估肥胖患者行微创和开放肾上腺切除治疗嗜铬细胞瘤后的结局，并确定可能影响结局的因素。回顾了2012年至2022年间在46个国际中心接受嗜铬细胞瘤肾上腺切除术的患者，分析其基线信息、住院时间（LOS）和术后并发症。
患者与方法
比较肥胖（体重指数（BMI）≥30kg/m²）和非肥胖患者。采用多变量分析评估结局以及并发症、住院时间和综合并发症指数（CCI）升高的危险因素。
结果
在2016例患者中，639例（31.7%）患有肥胖症。手术时间（110.0对105.0分钟；p = 0.467）、转为开放手术率（3.1%对4.7%；p = 0.079）、估计失血量（20.0对20.0毫升，p = 0.088）、并发症发生率（19.3%对20.8%；p = 0.425）和CCI相似。然而，肥胖患者的中位住院时间需要延长1天（4.0天对5.0天；p < 0.001）。在多变量分析中，肥胖与并发症或更高的CCI无显著相关性。仅对肥胖患者进行分析时，腹腔镜（OR 0.24；p < 0.001）和机器人手术（OR 0.22；p = 0.011）方法与较低的发病率独立相关。此外，多变量模型显示，BMI≥30kg/m²的患者采用腹膜后入路与降低CCI独立相关（-3.74；p = 0.017）。分析重度肥胖（BMI≥35）时也得到了类似结果。
结论
肥胖在嗜铬细胞瘤切除术后不会增加并发症或CCI，但会增加住院时间。腹膜后入路可能对肥胖患者有独特的益处。鉴于肥胖率不断上升，这些结果值得进一步研究以验证。
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