Fahim Mohamed I, Shafeik Fady, Khalil El Sayed Ashraf, Ali Abdelmaksoud M, Allam Rasha M, Asaad Marina
Surgical Oncology, National Cancer Institute, Cairo University, Cairo, EGY.
Oncosurgery, National Cancer Institute, Cairo, EGY.
Cureus. 2025 Aug 8;17(8):e89621. doi: 10.7759/cureus.89621. eCollection 2025 Aug.
Aim of the study This study aims to report our institutional outcomes of laparoscopic adrenalectomy, to compare these with a cohort of patients undergoing open adrenalectomy, and to describe the feasibility and utility of technical modifications, including modified port positioning and the use of intra-abdominal gauze retractors. Patients and methods This retrospective cohort study included 83 patients with radiologically benign-appearing adrenal tumors who underwent adrenalectomy at the National Cancer Institute (NCI), Cairo University, Cairo, Egypt, between January 2014 and January 2020. Patient data were extracted from medical records and included demographics (age and gender), lesion characteristics (size, laterality, and functional status), surgical approach (laparoscopic or open), and results of endocrine investigations (serum metanephrines, urinary vanillylmandelic acid (VMA), aldosterone, cortisol, sodium, and potassium). Results Of the 83 patients, 57 (68.7%) underwent right adrenalectomy, and 26 (31.3%) had left adrenalectomy. Functioning adrenal lesions were identified in 32 patients (38.6%), including 31 pheochromocytomas and one cortisol-secreting tumor; the remaining 51 patients (61.4%) had non-functioning lesions. There was a statistically significant difference in pathological lesion size between patients undergoing open versus laparoscopic adrenalectomy (p = 0.014). No mortality was recorded in the open group; however, one postoperative death occurred in the laparoscopic cohort. Conclusion Laparoscopic adrenalectomy appears to be a feasible technique in selected patients with benign-appearing adrenal lesions, particularly for lesions up to 6 cm. Technical modifications, including modified port positioning and the use of gauze retractors, were subjectively found to facilitate operative exposure. However, due to the study's retrospective design and limited sample size, no definitive conclusions can be drawn regarding comparative safety or effectiveness. Further prospective studies are needed to validate these findings.
研究目的 本研究旨在报告我们机构的腹腔镜肾上腺切除术的结果，将其与接受开放性肾上腺切除术的一组患者进行比较，并描述技术改进（包括改良的端口定位和使用腹腔内纱布牵开器）的可行性和实用性。
患者与方法 这项回顾性队列研究纳入了2014年1月至2020年1月期间在埃及开罗开罗大学国家癌症研究所接受肾上腺切除术的83例影像学表现为良性的肾上腺肿瘤患者。患者数据从医疗记录中提取，包括人口统计学信息（年龄和性别）、病变特征（大小、侧别和功能状态）、手术方式（腹腔镜或开放）以及内分泌检查结果（血清间甲肾上腺素、尿香草扁桃酸（VMA）、醛固酮、皮质醇、钠和钾）。
结果 83例患者中，57例（68.7%）接受了右侧肾上腺切除术，26例（31.3%）接受了左侧肾上腺切除术。32例患者（38.6%）发现有功能性肾上腺病变，包括31例嗜铬细胞瘤和1例分泌皮质醇的肿瘤；其余51例患者（61.4%）有非功能性病变。接受开放性肾上腺切除术与腹腔镜肾上腺切除术的患者在病理病变大小上存在统计学显著差异（p = 0.014）。开放组未记录到死亡；然而，腹腔镜队列中有1例术后死亡。
结论 对于部分影像学表现为良性的肾上腺病变患者，特别是对于直径达6 cm的病变，腹腔镜肾上腺切除术似乎是一种可行的技术。主观上发现包括改良端口定位和使用纱布牵开器在内的技术改进有助于手术暴露。然而，由于本研究的回顾性设计和样本量有限，关于比较安全性或有效性无法得出明确结论。需要进一步的前瞻性研究来验证这些发现。
