Viëtor Charlotte L, van Egmond Inge S, Franssen Gaston J H, Verhoef Cornelis, Feelders Richard A, van Ginhoven Tessa M
Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Updates Surg. 2025 Jan;77(1):183-191. doi: 10.1007/s13304-024-02043-7. Epub 2024 Dec 7.
Adrenal masses are being found more and more often over the years. Given the association of these masses with advancing age, the decision to perform surgery in older, sometimes asymptomatic patients presents a clinical dilemma. These patients are potentially more vulnerable to adverse postoperative outcomes due to increased frailty. Therefore, this study aimed to compare the postoperative course after adrenalectomy in patients aged 70 years and older to that of a younger cohort. This single center retrospective study included patients aged ≥ 70 years who underwent adrenalectomy between 2000-2020, and propensity-score matched younger patients (< 70 years). Patients were matched based on hormonal overproduction, malignant diagnosis, surgical approach and year of surgery. The study included 77 elderly patients (median age 74 years) and 77 younger patients (median age 52 years; p < 0.001). Serious complications (Clavien-Dindo ≥ 3) occurred in 9.1% of elderly patients and 6.5% of the matched younger cohort (p = 0.773). The overall complication rate was 44.2% in elderly and 40.3% in younger patients (p = 0.771), with similar duration of hospital admission and mortality in both groups. Elderly patients experienced mostly infectious (33.8%) or cardiovascular complications (27.0%), and cardiovascular complications were more frequent in elderly than in younger patients (6.7%, p = 0.039). In conclusion, patients aged 70 years and older who undergo adrenalectomy have a similar postoperative course and complication rate as younger patients, with most postoperative complications being minor, and mortality being minimal. Therefore, older age itself should not be a reason to refrain from adrenalectomy.
多年来，肾上腺肿块的发现越来越频繁。鉴于这些肿块与年龄增长有关，对于老年、有时无症状的患者而言，决定是否进行手术存在临床困境。由于身体虚弱加剧，这些患者术后出现不良后果的可能性更大。因此，本研究旨在比较70岁及以上患者肾上腺切除术后的病程与较年轻队列的病程。这项单中心回顾性研究纳入了2000年至2020年间接受肾上腺切除术的70岁及以上患者，以及倾向评分匹配的较年轻患者（<70岁）。根据激素分泌过多、恶性诊断、手术方式和手术年份对患者进行匹配。该研究包括77名老年患者（中位年龄74岁）和77名较年轻患者（中位年龄52岁；p<0.001）。9.1%的老年患者和6.5%的匹配较年轻队列出现严重并发症（Clavien-Dindo≥3级）（p=0.773）。老年患者的总体并发症发生率为44.2%，较年轻患者为40.3%（p=0.771），两组的住院时间和死亡率相似。老年患者主要经历感染性并发症（33.8%）或心血管并发症（27.0%），且老年患者的心血管并发症比年轻患者更常见（6.7%，p=0.039）。总之，70岁及以上接受肾上腺切除术的患者术后病程和并发症发生率与较年轻患者相似，大多数术后并发症为轻度，死亡率极低。因此，高龄本身不应成为拒绝肾上腺切除术的理由。
