Ahmad Basil, Karunakaran Duva, Touma Naji J
Queen's University School of Medicine, Kingston, ON, Canada.
Department of Urology, Queen's University, Kingston, ON Canada.
Can Urol Assoc J. 2025 Feb;19(2):53-57. doi: 10.5489/cuaj.7852.
Management of adrenal disease requires a multidisciplinary approach often involving varied specialists. Surgical management has often overlapped between general surgeons, usually with an interest in surgical endocrinology, or urologists with minimally invasive surgical skills. The objectives of this study were to define perioperative outcomes of contemporary Canadian adrenal surgery and determine whether those outcomes are impacted by surgical subspecialty. As a secondary outcome, an assessment of the variability in the indications for adrenal surgery was carried out between the two surgical subspecialties.
A retrospective chart review of all adrenalectomies performed at our center from August 2013 to August 2023 was conducted. The only exclusion criterion was when an adrenalectomy was performed secondary to the main procedure. Data was collected and grouped under four categories: patient characteristics, indications for an adrenalectomy, procedural statistics, and perioperative patient outcomes.
A total of 121 adrenalectomies were performed in a period of just over 10 years. Of these, 103 were included in the analysis. Thirty-seven were performed by general surgery, whereas 66 were performed by urology. There were no significant differences in patients' age and Charlson comorbidity score between the two surgical specialties. The indications for the adrenalectomy were similar between the specialties, and were as follows: 32 (31.1%) for pheochromocytoma, 24 (23.3%) for a cortical functional lesion, 19 (18.4%) for a metastatectomy, 16 (15.5%) for size or growth, and 10 (9.7%) for adrenocortical carcinoma. There were no differences in overall operating room time or type of procedure. Most (89.3%) of the procedures were performed laparoscopically. Patients that were operated on by general surgeons were more likely to be readmitted within 30 days than those operated on by urologists (five patients [13.5%] vs. one patient [1.5%], respectively, p=0.04), and more likely to require intensive care unit (ICU)/stepdown ICU admission (19 patients [51.4%] vs. 19 [28.8%], respectively, p=0.04). There was no difference in length of stay or postoperative complications. There was, however, one Clavien-Dindo 5 complication after a procedure performed by general surgery.
Most adrenalectomies at this one Canadian center are performed by urology. Indications for adrenalectomy are similar between the specialties. Although postoperative complication rates are similar, rates of 30-day readmission and ICU/stepdown admission were decreased when urologists performed adrenalectomies. Adrenalectomies may be performed safely by either specialty, and factors such as local expertise and surgical volumes are likely important.
肾上腺疾病的管理需要多学科方法，通常涉及不同的专科医生。手术管理通常在普通外科医生（通常对手术内分泌学感兴趣）或具备微创外科技能的泌尿外科医生之间存在重叠。本研究的目的是确定当代加拿大肾上腺手术的围手术期结果，并确定这些结果是否受到手术专科的影响。作为次要结果，对两个手术专科之间肾上腺手术指征的变异性进行了评估。
对2013年8月至2023年8月在我们中心进行的所有肾上腺切除术进行回顾性病历审查。唯一的排除标准是肾上腺切除术作为主要手术的继发手术。数据收集并分为四类：患者特征、肾上腺切除术指征、手术统计数据和围手术期患者结果。
在略超过10年的时间里共进行了121例肾上腺切除术。其中，103例纳入分析。普通外科进行了37例，而泌尿外科进行了66例。两个手术专科在患者年龄和查尔森合并症评分方面无显著差异。两个专科之间肾上腺切除术的指征相似，如下：嗜铬细胞瘤32例（31.1%），皮质功能性病变24例（23.3%），转移瘤切除术19例（18.4%），因大小或生长16例（15.5%），肾上腺皮质癌10例（9.7%）。总体手术时间或手术类型无差异。大多数手术（89.3%）通过腹腔镜进行。普通外科医生手术治疗的患者比泌尿外科医生手术治疗的患者更有可能在30天内再次入院（分别为5例[13.5%]对1例[1.5%]，p = 0.04），并且更有可能需要重症监护病房（ICU）/降级ICU入院（分别为19例[51.4%]对19例[28.8%]，p = 0.04）。住院时间或术后并发症无差异。然而，普通外科进行的一例手术后出现了一例Clavien-Dindo 5级并发症。
该加拿大中心的大多数肾上腺切除术由泌尿外科进行。两个专科之间肾上腺切除术的指征相似。虽然术后并发症发生率相似，但泌尿外科进行肾上腺切除术时30天再入院率和ICU/降级入院率降低。两个专科都可以安全地进行肾上腺切除术，当地专业知识和手术量等因素可能很重要。
