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Özbebit O, Çarkıt S, Karaağaç M, Gök M, Öz B, Doğan S, Öztürk F, Öztürk A, Akcan A. The effect of obesity on the outcomes of laparoscopic adrenal surgery in patients with Cushing syndrome. Ann Surg Treat Res 2024; 107:100-107. [PMID: 39139828 PMCID: PMC11317362 DOI: 10.4174/astr.2024.107.2.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 08/15/2024] Open
Abstract
Purpose The aim of this study is to investigate the effect of obesity on the results of laparoscopic adrenal surgery in patients with Cushing syndrome. Methods This retrospective study was performed in Department of General Surgery at Erciyes University School of Medicine between January 2010 and January 2023. Our analysis included Cushing syndrome patients who underwent unilateral laparoscopic adrenalectomy (LA) with the transabdominal lateral approach. All patients were evaluated in terms of age, sex, tumor diameter, body mass index (BMI), American Society of Anesthesiologists physical status classification, morbidities, surgery history, tumor side, operative time, conversion to open surgery, complications, and length of hospital stay. Results A total of 90 patients (75 females and 15 males) underwent a transperitoneal LA. Patients were divided into 2 groups according to their BMI: obese group (≥30 kg/m2; n = 53, 58.8%) and nonobese group (<30 kg/m2; n = 37, 41.2%). All patients were classified into 3 subgroups: obese patient group, BMI ≥30-39 kg/m2 (n = 23); morbidly obese patient group, BMI ≥40 kg/m2 (n = 14); and nonobese patient group, BMI <30 kg/m2 (n = 53). There was no significant difference in intraoperative complications, conversion to open surgery, operative time, or length of hospital stay between the groups. Only conversion to open surgery was a risk factor for postoperative complications in univariate and multivariate analyses (odds ratio, 15.4; 95% confidence interval, 1.277-185.599; P = 0.031). Conclusion Our results showed that LA is safe and effective in patients with Cushing syndrome with morbid obesity, allowing acceptable morbidity and length of hospital stay.
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Affiliation(s)
- Orkun Özbebit
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Sedat Çarkıt
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Mustafa Karaağaç
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Mustafa Gök
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Bahadır Öz
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Serap Doğan
- Department of Radiology, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Figen Öztürk
- Department of Pathology, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Ahmet Öztürk
- Department of Biostatistics, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Alper Akcan
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
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Saini V, Garg R, Kataria K, Nelson T. True mesothelial cyst of the adrenal gland: its clinical profile and management. BMJ Case Rep 2024; 17:e258485. [PMID: 38395468 PMCID: PMC10895221 DOI: 10.1136/bcr-2023-258485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
The incidence of adrenal cysts is 0.06% and only 9% of these are true mesothelial cysts. Here, we present a case of a true mesothelial cyst together with a review of the literature. A female in her 30s presented to the surgical outpatient department complaining of right flank pain. Her contrast-enhanced CT scan revealed a 7.5×6.5×4.5 cm right adrenal gland cyst. The patient underwent a laparoscopic right adrenalectomy. Immunohistopathology revealed the cyst to be mesothelial in nature. The majority of true mesothelial adrenal cysts are benign, unilateral and more common in women. Any adrenal cyst diagnosed as a functional lesion or one that may be malignant or with a diameter of 5 cm or greater requires surgical care whereas smaller lesions can be managed conservatively. Laparoscopic adrenalectomy for an adrenal cyst of diameter greater than 6 cm is a safe and feasible procedure in expert hands if there is no invasion of surrounding tissue.
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Affiliation(s)
- Vikram Saini
- Department of Surgical Discipline, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Richa Garg
- Department of Surgical Discipline, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Kamal Kataria
- Department of Surgical Discipline, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Fischer A, Schöffski O, Nießen A, Hamm A, Langan EA, Büchler MW, Billmann F. Retroperitoneoscopic adrenalectomy may be superior to laparoscopic transperitoneal adrenalectomy in terms of costs and profit: a retrospective pair-matched cohort analysis. Surg Endosc 2023; 37:8104-8115. [PMID: 37658201 PMCID: PMC10519868 DOI: 10.1007/s00464-023-10395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/13/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND A direct comparison of the cost-benefit analysis of retroperitoneoscopic adrenalectomy (RPA) versus the minimally invasive transperitoneal access (LTA) approach is currently lacking. We hypothesized that RPA is more cost effective than LTA; promising significant savings for the healthcare system in an era of ever more limited resources. METHODS We performed a monocentric retrospective observational cohort study based on data from our Endocrine Surgery Registry. Patients who were operated upon between 2019 and 2022 were included. After pair-matching, both cohorts (RPA vs. LTA) were compared for perioperative variables and treatment costs (process cost calculation), revenue and profit. RESULTS Two homogenous cohorts of 43 patients each (RPA vs. LTA) were identified following matching. Patient characteristics between the cohorts were comparable. In terms of both treatment-associated costs and profit, the RPA procedure was superior to LTA (costs: US$5789.99 for RPA vs. US$6617.75 for LTA, P = 0.043; profit: US$1235.59 for RPA vs. US$653.33 for LTA, P = 0.027). The duration of inpatient treatment and comorbidities significantly influenced the cost of treatment and the overall profit. CONCLUSIONS RPA appears not only to offer benefits over LTA in terms of perioperative morbidity and length of hospital stay, but also has a superior financial cost/benefit profile.
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Affiliation(s)
- Andreas Fischer
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Oliver Schöffski
- Fachbereich Wirtschaftswissenschaften, Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-University Erlangen-Nürnberg, Lange Gasse 20, 90403, Nürnberg, Germany
| | - Anna Nießen
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Alexander Hamm
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Ewan A Langan
- Department of Dermatology, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Department of Dermatological Science, University of Manchester, Manchester, UK
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Franck Billmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Beninato T, Duh QY, Long KL, Kiernan CM, Miller BS, Patel S, Randle RW, Wachtel H, Zanocco KA, Zern NK, Drake FT. Challenges and controversies in adrenal surgery: A practical approach. Curr Probl Surg 2023; 60:101374. [PMID: 37770163 DOI: 10.1016/j.cpsurg.2023.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Toni Beninato
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Quan-Yang Duh
- Veterans Affairs Medical Center, San Francisco, San Francisco, CA
| | | | - Colleen M Kiernan
- Vanderbilt University Medical Center, Veterans Affairs Medical Center, Tennessee Valley Health System, Nashville, TN
| | - Barbra S Miller
- Division of Surgical Oncology, The Ohio State University, Columbus, OH
| | - Snehal Patel
- Emory University School of Medicine, Atlanta, GA
| | | | | | - Kyle A Zanocco
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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Conzo G, Patrone R, Flagiello L, Catauro A, Conzo A, Cacciatore C, Mongardini FM, Cozzolino G, Esposito R, Pasquali D, Bellastella G, Esposito K, Docimo L. Impact of Current Technology in Laparoscopic Adrenalectomy: 20 Years of Experience in the Treatment of 254 Consecutive Clinical Cases. J Clin Med 2023; 12:4384. [PMID: 37445419 DOI: 10.3390/jcm12134384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA), which avoids large abdomen incisions, is considered the gold standard technique for the treatment of benign small- and medium-size adrenal masses (<6 cm) and weighing < 100 g. A trascurable mortality and morbidity rate, short hospitalization and patient rapid recovery are the main advantages compared to traditional surgery. During the past decade, a new surgical technology has been developed that expedites a "clipless" adrenalectomy. Here, the authors analyze a clinical series of 254 consecutive patients who were affected by adrenal gland neoplasms and underwent LA by the transabdominal lateral approach over the two last decades. A literature review is also presented. METHODS Preoperative, intraoperative and postoperative data from 254 patients who underwent LA between January 2003 and December 2022 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in the case of pheochromocytoma (PCC) while spironolactone and potassium were employed to treat Conn's disease. The same surgeon (CG) performed all the LA and utilized the same laparoscopic transabdominal lateral approach. Different dissection tools-ultrasonic, bipolar or mixed scissors-and hemostatic agents were used during this period. The following results were obtained: 254 patients were included in the study; functioning tumors were diagnosed in 155 patients, 52 patients were affected by PCCs, 55 by Conn's disease, 48 by Cushing's disease. Surgery mean operative time was 137.33 min (range 100-180 min) during the learning curve adrenalectomies and 98.5 min (range 70-180) in subsequent procedures. Mean blood loss was respectively 160.2 mL (range 60-280) and 96.98 mL (range 50-280) in the first 30 procedures and the subsequent ones. Only three conversions (1.18%) to open surgery occurred. No mortality or postoperative major complications were observed, while minor complications occurred in 19 patients (3.54%). In 153 out of 155 functioning neoplasms, LA was effective in the normalization of the endocrine profile. According to our experience, a learning curve consisting of 30 cases was identified. In fact, a lower operative time and a lower complication rate was reported following 30 LA. CONCLUSIONS LA is a safe procedure, even for masses larger than 6 cm and PCCs. Undoubtedly, the development of surgical technology has made it possible reducing operative times, performing a "clipless" adrenalectomy and extending the indications in the treatment of more complex patients. A multidisciplinary team, in referral high-volume centers, is recommended in the management of adrenal pathology. A 30-procedure learning curve is necessary to improve surgical outcomes.
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Affiliation(s)
- Giovanni Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Renato Patrone
- Dieti Department, University of Naples Federico II, 80100 Naples, Italy
- Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Luigi Flagiello
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Antonio Catauro
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Alessandra Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Chiara Cacciatore
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Giovanni Cozzolino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Rosetta Esposito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Daniela Pasquali
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80100 Naples, Italy
| | - Giuseppe Bellastella
- Division of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Second University of Naples, 80138 Naples, Italy
| | - Katherine Esposito
- Diabetes Unit, Department of Clinical and Experimental Medicine, Second University of Naples, 80138 Naples, Italy
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
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Davey MG, Ryan ÉJ, Donlon NE, Ryan OK, Al Azzawi M, Boland MR, Kerin MJ, Lowery AJ. Comparing surgical outcomes of approaches to adrenalectomy - a systematic review and network meta-analysis of randomised clinical trials. Langenbecks Arch Surg 2023; 408:180. [PMID: 37145303 PMCID: PMC10163131 DOI: 10.1007/s00423-023-02911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND No randomised clinical trials (RCTs) have simultaneously compared the safety of open (OA), transperitoneal laparoscopic (TLA), posterior retroperitoneal (PRA), and robotic adrenalectomy (RA) for resecting adrenal tumours. AIM To evaluate outcomes for OA, TLA, PRA, and RA from RCTs. METHODS A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. RESULTS Eight RCTs with 488 patients were included (mean age: 48.9 years). Overall, 44.5% of patients underwent TLA (217/488), 37.3% underwent PRA (182/488), 16.4% underwent RA (80/488), and just 1.8% patients underwent OA (9/488). The mean tumour size was 35 mm in largest diameter with mean sizes of 44.3 mm for RA, 40.9 mm for OA, 35.5 mm for TLA, and 34.4 mm for PRA (P < 0.001). TLA had the lowest blood loss (mean: 50.6 ml), complication rates (12.4%, 14/113), and conversion to open rates (1.3%, 2/157), while PRA had the shortest intra-operative duration (mean: 94 min), length of hospital stay (mean: 3.7 days), lowest visual analogue scale pain scores post-operatively (mean: 3.7), and was most cost-effective (mean: 1728 euros per case). At NMA, there was a significant increase in blood loss for OA (mean difference (MD): 117.00 ml (95% confidence interval (CI): 1.41-230.00)) with similar blood loss observed for PRA (MD: - 10.50 (95% CI: - 83.40-65.90)) compared to TLA. CONCLUSION LTA and PRA are important contemporary options in achieving favourable outcomes following adrenalectomy. The next generation of RCTs may be more insightful for comparison surgical outcomes following RA, as this approach is likely to play a future role in minimally invasive adrenalectomy. PROSPERO REGISTRATION CRD42022301005.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland.
- Department of Surgery, Galway University Hospitals, Galway, H91YR71, Republic of Ireland.
| | - Éanna J Ryan
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Noel E Donlon
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Odhrán K Ryan
- Surgical Professorial Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| | - Mohammed Al Azzawi
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Michael R Boland
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Michael J Kerin
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland
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Eid M, Foukal J, Sochorová D, Tuček Š, Starý K, Kala Z, Mayer J, Němeček R, Trna J, Kunovský L. Management of pheochromocytomas and paragangliomas: Review of current diagnosis and treatment options. Cancer Med 2023. [PMID: 37145019 DOI: 10.1002/cam4.6010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023] Open
Abstract
Pheochromocytomas (PCCs) are rare neuroendocrine tumors derived from the chromaffin cells of the adrenal medulla. When these tumors have an extra-adrenal location, they are called paragangliomas (PGLs) and arise from sympathetic and parasympathetic ganglia, particularly of the para-aortic location. Up to 25% of PCCs/PGLs are associated with inherited genetic disorders. The majority of PCCs/PGLs exhibit indolent behavior. However, according to their affiliation to molecular clusters based on underlying genetic aberrations, their tumorigenesis, location, clinical symptomatology, and potential to metastasize are heterogenous. Thus, PCCs/PGLs are often associated with diagnostic difficulties. In recent years, extensive research revealed a broad genetic background and multiple signaling pathways leading to tumor development. Along with this, the diagnostic and therapeutic options were also expanded. In this review, we focus on the current knowledge and recent advancements in the diagnosis and treatment of PCCs/PGLs with respect to the underlying gene alterations while also discussing future perspectives in this field.
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Affiliation(s)
- Michal Eid
- Department of Hematology, Oncology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jakub Foukal
- Department of Radiology and Nuclear Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Dana Sochorová
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Štěpán Tuček
- Department of Hematology, Oncology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Karel Starý
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zdeněk Kala
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiří Mayer
- Department of Hematology, Oncology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Radim Němeček
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Trna
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Lumír Kunovský
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
- 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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Collins RA, Wang TS, Dream S, Solórzano CC, Kiernan CM. Adoption of Robotic Adrenalectomy: A Two-Institution Study of Surgeon Learning Curve. Ann Surg Oncol 2023:10.1245/s10434-023-13406-6. [PMID: 37040047 DOI: 10.1245/s10434-023-13406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/08/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Robotic adrenalectomy is feasible and safe, yet concerns over increased operative times and the learning curve (LC) for proficiency have limited its adoption. This study aimed to assess the LC for robotic adrenalectomy. METHODS This is a two-institution retrospective review of consecutive unilateral minimally invasive adrenalectomies performed by four high-volume adrenal surgeons between 2007 and 2022. Two surgeons transitioned from laparoscopic to robotic adrenalectomy, and two surgeons adopted the approach, with proctoring, after completion of fellowship training without robotic experience. Operative time and complications were analyzed. Multivariable regression was used to identify factors associated with operative time. The number of cases required to overcome the LC was determined using the LC-cumulative-sum (LC-CUSUM) analysis. RESULTS Of 457 adrenalectomies, 182 (40%) were laparoscopic and 275 (60%) robotic. The robotic approach was associated with shorter median operative time (106 vs 119 min; p = 0.002), fewer complications (6% vs 13%; p = 0.018), and fewer conversions to open adrenalectomy (1% vs 4%; p = 0.030), with no difference between the senior and junior surgeons. On adjusted analysis, factors associated with increased operative time were male sex (p < 0.001), BMI > 30 kg/m2 (p < 0.001), and higher gland weight (p < 0.001). The LC-CUSUM analysis showed proficiency after 8-29 procedures. Compared with the first 10 cases, there was a mean reduction in operative time of 14 min after 10-20 cases, 28 min after 20-30 cases, and 29 min after > 30 cases, regardless of surgeon experience. DISCUSSION With dedicated teams and proctoring, robotic adrenalectomy can be safely adopted at high-volume centers with a minimal LC.
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Affiliation(s)
- Reagan A Collins
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Tracy S Wang
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sophie Dream
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carmen C Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Colleen M Kiernan
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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9
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Laparoscopic adrenalectomy for adrenal metastases of solid tumors. Surg Endosc 2023:10.1007/s00464-023-09961-4. [PMID: 36869264 DOI: 10.1007/s00464-023-09961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/12/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION In patients with history of cancer adrenal metastases can be found in up to 70% of adrenal tumors detected during follow-up. Currently, laparoscopic adrenalectomy (LA) is considered the gold standard approach for benign adrenal tumors but is still controversial in malignant disease. Depending on the patient's oncological status, adrenalectomy might be a possible treatment option. Our objective was to analyze the results of LA for adrenal metastasis from solid tumors in two referral centers. METHODS Retrospective analysis of 17 patients with non-primary adrenal malignancy treated with LA between 2007 and 2019 was performed. Demographic and primary tumor data, type of metastasis, morbidity, disease recurrence and evolution were evaluated. Patients were compared according to type of metastases: synchronous (< 6 months) vs metachronous (≥ 6 months). RESULTS 17 patients were included. Median metastatic adrenal tumor size was 4 cm (IQR, 3-5.4). We had one conversion to open surgery. Recurrence was found in 6 patients with one recurring in the adrenal bed. The median OS was 24 (IQR, 10.5-60.5) months and 5-year OS was 61.4% (95%CI: 36.7%-81.4%). Patients with metachronous metastases had better overall survival vs. patients with synchronous metastases (87% vs. 14%, p = 0.0037). CONCLUSION LA for adrenal metastases is a procedure associated with low morbidity and acceptable oncologic outcomes. Based on our results, seems reasonable to offer this procedure to carefully selected patients, mainly those with metachronous presentation. Indication of LA must be done on a case by case evaluation in the context of a multidisciplinary tumor board.
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10
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Corallino D, Balla A, Palmieri L, Sperduti I, Ortenzi M, Guerrieri M, Paganini AM. Is transperitoneal laparoscopic adrenalectomy for pheochromocytoma really more challenging? A propensity score-matched analysis. J Endocrinol Invest 2023:10.1007/s40618-023-02013-7. [PMID: 36705839 DOI: 10.1007/s40618-023-02013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE Minimally invasive surgery is the gold standard treatment for adrenal masses, but it may be a challenging procedure in the case of pheochromocytoma (PHEO). The aim of the present study is to report the results of transperitoneal laparoscopic adrenalectomy (TLA) in cases of PHEO in comparison to other types of adrenal lesions. METHODS From 1994 to 2021, 629 patients underwent adrenalectomy. Twenty-two and thirty-five patients, respectively, were excluded because they underwent bilateral and open adrenalectomy, leaving 572 patients for inclusion. Of these, 114 patients had PHEO (Group A), and 458 had other types of lesions (Group B). To adjust for potential baseline confounders, a propensity score matching (PSM) analysis was conducted. RESULTS After PSM, 114 matched pairs of patients were identified from each group. Statistically significant differences were not observed when comparing the median operative time (85 and 90 min in Groups A and B, respectively, p = 0.627), conversion rate [6 (5.3%) in each group, p = 1.000], transfusion rate [4 (3.5%) and 3 (2.6%) in Groups A and B, respectively, p = 1.000], complication rate [7 (6.1%) and 9 (7.9%) in Groups A and B, respectively, p = 0.796), median postoperative hospital stay (3.9 and 3.6 days in Groups A and B, respectively, p = 0.110), and mortality rate [1 (0.9%) in each group, p = 1.000]. CONCLUSIONS Based on this analysis, the results of TLA for PHEO are equivalent to those of TLA for other types of adrenal lesions, but the fundamental requirements are multidisciplinary patient management and adequate surgeon experience. Further prospective studies are required to draw definitive conclusions.
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Affiliation(s)
- D Corallino
- Department of General Surgery and Surgical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - A Balla
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, 00053, Civitavecchia, Rome, Italy
| | - L Palmieri
- Department of General Surgery and Surgical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - I Sperduti
- Department of Biostatistics, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - M Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - M Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - A M Paganini
- Department of General Surgery and Surgical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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Olivero A, Liu K, Checchucci E, Liu L, Ma L, Wang G, Mantica G, Tappero S, Amparore D, Sica M, Fiori C, Huang Q, Niu S, Wang B, Ma X, Hou X, Porpiglia F, Terrone C, Zhang X. Adrenocortical carcinoma with venous tumor invasion: is there a role for mini-invasive surgery? Langenbecks Arch Surg 2023; 408:17. [PMID: 36625975 DOI: 10.1007/s00423-023-02765-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study aims to investigate early oncologic outcomes in patients with adrenocortical carcinoma (ACC) with venous invasion (VI) treated using both open and mini-invasive approaches. PATIENTS AND MATERIALS We conducted a retrospective analysis of 4 international referral center databases, including all the patients undergoing adrenalectomy for ACC with VI from January 2007 to March 2020. According to CT scan or MRI, the tumor thrombus was classified into four levels: (1) adrenal vein invasion; (2) renal vein invasion; (3) infra-hepatic Inferior vena cava (IVC); and (4) retro-hepatic IVC. In addition, we divided our patients into patients who had undergone open surgery and mini-invasive surgery. RESULTS We identified 20 patients with a median follow-up of 12 months. The median tumor size was 110mm. ENSAT stage was II in 4 patients, III in 13 patients, and IV in 3 patients. Tumor thrombus extended in the adrenal vein (n=5), renal vein (n=1), infra-hepatic IVC (n=9), or into the retro-hepatic IVC (n=5). Ten patients were treated with a mini-invasive approach. The patient treated with an open approach reported a more aggressive disease. The two groups did not differ in surgical margins, surgical time, blood losses, complications, and length of stay. The prognosis resulted worse in the patient undergoing open. Kaplan-Meier analysis indicated a difference in OS for the patients stratified by ENSAT stage (Log-rank p=0.011); we also reported a difference in DFS for patients stratified for thrombus extension (p=0.004) and ENSAT stage (p<0.001). CONCLUSION The DFS of patients with VI from ACC is influenced by the staging and the extension of the venous invasion; the staging influences the OS. The mini-invasive approach seems feasible in selected patients; however, further studies investigating the oncological outcomes are needed. A mini-invasive approach for adrenal tumors with venous invasion is an explorable option in very selected patients.
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Affiliation(s)
- Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy.
| | - Kan Liu
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Enrico Checchucci
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Lei Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Stefano Tappero
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Michele Sica
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Quingbo Huang
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Shaoxi Niu
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Baojun Wang
- Department of Urology, Chinese PLA General Hospital, Beijing, China.
| | - Xin Ma
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Xiaofei Hou
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing, China
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Păun SC, Tănase I, Stoica B, Mirică A, Păun DL. Tips and Tricks in Laparoscopic Adrenalectomy for Pheochromocytoma. How We Do It. ROMANIAN JOURNAL OF MILITARY MEDICINE 2023. [DOI: 10.55453/rjmm.2023.126.3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
"Pheochromocytomas are rare neuroendocrine tumors that frequently have genetic involvement and can present a particular risk in terms of the anesthetic-surgical procedure. Current worldwide medical recommendations state that laparoscopic adrenalectomy is the conventional treatment for pheochromocytoma, however, the ideal surgical strategy is still being developed as specialized surgeons gain experience with these rare tumors. The study's purpose was to thoroughly evaluate our film library and identify the best surgical steps that represent our standardized procedure. We developed a comprehensive set of surgical critical strategies for either a left or right adrenalectomy, providing helpful advice on patient positioning, port placement, the adrenal gland approach, as well as other surgical methods specifically designed for tumor mobilization and dissection. The current paper aims to synthesize our clinical experience in terms of preoperative preparation, patient positioning, intraoperative complications, causes of conversion, and specimen extraction. The main conclusions concern both the best surgical approach and the importance of surgical experience in the clinical management of these rare tumor types. "
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Wang W, Zhou H, Sun A, Xiao J, Wang D, Huang D. Anesthetic management of a giant paraganglioma resection: a case report. BMC Anesthesiol 2022; 22:212. [PMID: 35820846 PMCID: PMC9277950 DOI: 10.1186/s12871-022-01766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with pheochromocytomas are often diagnosed with acute myocardial infarction (AMI) due to initial symptoms of palpitations and chest tightness. We describe a case of AMI syndrome where a giant paraganglioma was unexpectedly identified. The anesthetic management of the paraganglioma resection was challenging and complex. CASE PRESENTATION A 66-year-old woman was admitted to the emergency department for complaints of palpitations, chest tightness and vomiting. A laboratory test revealed that troponin I and N-terminal pro-brain natriuretic peptide levels were dramatically increased. Emergency percutaneous coronary angiography (CAG) showed normal coronary arteries. In addition, the serum levels of free catecholamines were increased, and computed tomography and magnetic resonance imaging revealed a heterogenous mass lesion in the right retroperitoneal. All of this ultimately confirmed the diagnosis of pheochromocytoma. After three weeks of careful preoperative preparation by a multidisciplinary team, and an anesthesiologist team develops detailed perianesthesia management strategies to maintain hemodynamics and blood glucose stability and regulate acid-base balance, pheochromocytoma resection was performed successfully. About 2 weeks later, the patient was discharged healthy. A postoperative pathology test confirmed paraganglioma. CONCLUSIONS To our knowledge, giant pheochromocytoma resection is a complex challenge for the anesthesiologists, this clinical case may supply a thoughtful experience for anesthetic management in the resection of giant pheochromocytomas. Adequate preoperative evaluation and prudent perianesthesia management by anesthesiologists are important guarantees for patients to obtain a good prognosis and discharge healthily.
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Affiliation(s)
- WeiBing Wang
- Department of Anesthesiology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
| | - Hui Zhou
- Department of Anesthesiology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
| | - AiJiao Sun
- Department of Cardiovascularology, The Affiliated AnQing Municipal Hospital of Anhui Medical University, 352th, Renming Road, AnQing, 246003, China.
| | - JingBo Xiao
- Department of Anesthesiology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
| | - DongShu Wang
- Department of General Surgery, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
| | - DaXiang Huang
- Department of Endocrinology, The Affiliated AnQing Municipal Hospitals of Anhui Medical University, AnQing, China
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Selvaraj N, Pooleri GK, Addla SK, Raghavan D, Govindaswamy TG, Balakrishnan AK, Sivaraman A, Jain N, Kandasamy SG, Ragavan N. Robot assisted laparoscopic adrenalectomy: Should this be the new standard? Urologia 2022; 89:430-436. [DOI: 10.1177/03915603221097166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Minimal invasive surgeries (MIS) for large size adrenal tumors are still debatable. The objective is to evaluate the contemporary peri- and post-operative outcomes of patients undergoing (open = OA, laparoscopic = LA, and robotic = RA) adrenalectomies in three institutions. Materials and methods: Retrospectively gathered peri- and post-operative data of 235 patients, underwent adrenalectomy at three Institutions over a 7-year period (2013–2020) were analyzed. All patients underwent thorough radiological and endocrine workup. Results: Two hundred and thirty five patients who underwent adrenalectomy (OA ( n = 29), LA ( n = 146), and RA ( n = 60)) were assessed. OA ( n = 29) versus Minimally invasive surgery ( n = 206) showed significant differences (median, p value) in larger tumour size, cm (9.4 vs 5, ( p = 0.0001)), longer operative time, mins (240 vs 100, ( p = 0.0001)), longer hospital stay, days (8 vs 3,( p = .0001)), Higher readmission rates (14% vs 1.9%), higher blood loss, ml (400 vs 100, ( p = 0.0001)) requiring blood transfusion (14% vs 4.3%) ( p = 0.03), higher intraoperative complication (21% vs 6%) ( p = 0.0004), and post op complications (17% vs 5.3%) ( p = 0.01). Amongst the MIS (RA vs LA), RA appeared be have better outcomes in terms of shorter operative time, less blood loss and less intra operative complications with a p value <0.05. These results were consistent for the assessment of patients who had ⩾6 cm tumor size. The postoperative complication rates were lowest with RA (3.3%) compared to OA (17%) and LA (6.1%). Conclusions: Contemporary practice of adrenalectomy shows that robotic adrenalectomy is safe and effective irrespective of the tumor size.
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Affiliation(s)
- Nivash Selvaraj
- Department of Urology, Apollo Main Hospitals, Chennai, India
| | | | - Sanjai Kumar Addla
- Department of Urooncology, Apollo Cancer Institutes, Jubilee Hills, Hyderabad, India
| | - Deepak Raghavan
- Department of Urology, Apollo Main Hospitals, Chennai, India
| | | | | | | | - Nitesh Jain
- Department of Urology, Apollo Main Hospitals, Chennai, India
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Duralska M, Dzwonkowski J, Sierdziński J, Nazarewski S. High-Volume Center Experience with Laparoscopic Adrenalectomy over Two Decades. J Clin Med 2022; 11:jcm11092335. [PMID: 35566460 PMCID: PMC9102790 DOI: 10.3390/jcm11092335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/09/2022] [Accepted: 04/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Study aims to demonstrate single-institution two decades experience with lateral transperitoneal laparoscopic adrenalectomies. Methods: Retrospective study involved 991 operations grouped into 4 cohorts. Data was collected on the patients’ age, sex, side and size of the lesion, histopathological type, hormonal activity, conversion to open adrenalectomy, operating time, length of hospital stay, perioperative complications. Results: The operations were right-sided (n = 550), left-sided (n = 422), bilateral (n = 19). Mean tumor size was 41.9 mm. Histopathological examination revealed 442 adenomas, 191 nodular hyperplasias, 218 pheochromocytomas, 33 malignancies and 126 other lesions. 541 patients had hormonally active tumors. Mean operating time for unilateral laparoscopic adrenalectomy was 141 min. Mean length of hospital stay was 5.27 days. Intraoperative complications rate was 2.3%. Conversion rate was 1.5%. 54 of patients had 70 postoperative complications. Reoperation rate was 1%. Mortality rate was 0.1%. Statistically significant differences were found in all factors, apart from age, sex, side and size of the lesion, reoperations rate (p > 0.05). Conversions rate, complications rates, length of hospital stay were highest in the first group (p < 0.05). Operating time shortened in the first decade. Conclusions: Laparoscopic adrenalectomy is a safe procedure with negligible mortality. Conversions rate, perioperative complications rate, and length of hospital stay, significantly decreased over time.
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Affiliation(s)
- Milena Duralska
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (J.D.); (S.N.)
- Correspondence:
| | - Jacek Dzwonkowski
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (J.D.); (S.N.)
| | - Janusz Sierdziński
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Sławomir Nazarewski
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (J.D.); (S.N.)
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Francis A, Mellert L, Parekh N, Pozsgay M, Dan A. Robotic Adrenalectomy: A 10-Year Clinical Experience at a Tertiary Medical Center. JSLS 2022; 26:JSLS.2021.00083. [PMID: 35444401 PMCID: PMC8993463 DOI: 10.4293/jsls.2021.00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: Laparoscopic adrenalectomy is now the preferred approach for most adrenal tumors. As minimally invasive surgery departments gain familiarity with the robotic platform, the safety profiles and efficacy of robotic adrenalectomy has been an area of continued discussion. The objective of this study is to outline our experience with transitioning to the robotic platform and determining the effectiveness and safety of transperitoneal robotic adrenalectomy. Methods: We performed a single-center, retrospective review of 37 patients who underwent transperitoneal robotic adrenalectomy between August 1, 2010 and August 31, 2020. Outcomes included patient morbidity, hospital length of stay, operative time, estimated blood loss, gland volume, pathology, and postoperative complications. Results: Sixty-five percent of the total robotic adrenalectomies were of the left adrenal gland. The average operating room time was 213 minutes. The average gland volume was 71 cm3, estimated blood loss was 74 mL and length of stay was 1.4 days. There were no significant differences in outcomes between the right and left total robotic adrenalectomies. Approximately one-third of our cohort had an adrenal cortical adenoma, while only one patient had adrenal cortical carcinoma. Four patients experienced postoperative complications that resulted in unplanned hospital readmissions and there was one mortality. Conclusions: Although the standard of care for most adrenal tumors is laparoscopic resection, our 10-year experience has shown that robotic adrenalectomy is highly effective and can be a valuable tool in the community and academic setting.
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Affiliation(s)
- Andrew Francis
- Department of General Surgery. Summa Health - Akron City Hospital, Akron, OH
| | - Logan Mellert
- Department of General Surgery. Summa Health - Akron City Hospital, Akron, OH
| | - Neel Parekh
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mark Pozsgay
- Department of General Surgery. Summa Health - Akron City Hospital, Akron, OH
| | - Adrian Dan
- Department of General Surgery. Summa Health - Akron City Hospital, Akron, OH
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17
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Zhou X, Li X, Fu B, Liu W, Zhang C, Xia Y, Gong H, Zhu L, Lei E, Kaplan J, Deng Y, Eun D, Wang G. The ADRENAL score: A comprehensive scoring system for standardized evaluation of adrenal tumor. Front Endocrinol (Lausanne) 2022; 13:1073082. [PMID: 36506046 PMCID: PMC9730271 DOI: 10.3389/fendo.2022.1073082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To propose an original and standardized scoring system to quantify the functional and anatomical characteristics of adrenal tumor. MATERIALS AND METHODS Four groups of consecutive adrenalectomies (n = 458) with heterogeneity in tumor characteristics and surgical approaches, including 212 laparoscopic cases (Group 1) and 105 robotic cases (Group 2) from The First Affiliated Hospital of Nanchang University, 28 robotic cases from Temple University Hospital (Group 3) and 113 laparoscopic cases from The First Affiliated Hospital of Guangxi Medical University (Group 4). All patients were followed up for 4.5 to 5.5 years. Six parameters including functional status or suspicion of malignancy, tumor size, relationship to adjacent organs, intratumoral enhancement on CT, nearness of the tumor to major vessels and body mass index were assessed and scored on a 0, 1 and 2 points scale. Correlation between the sum of the 6 scores and tumor laterality (ADRENAL score) verse operative time (OT), estimated blood loss (EBL), perioperative complications, transfusion, conversion and length of hospital stay was analyzed. RESULTS ADRENAL score was a strong predictor of both OT and EBL in all four groups (p < 0.05 for all tests). In Group 2 and 4, higher ADRENAL score seemed to correlate with longer hospital stay. No statistically significant correlation between ADRENAL score and complication, transfusion or conversion was noted yet. CONCLUSIONS ADRENAL score appears to be a valid predictor of surgical outcomes. It may provide a common reference for adrenal surgery training program, preoperative risk assessment and stratified comparative analysis of adrenal surgeries via different techniques and approaches.
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Affiliation(s)
- Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xuwen Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weipeng Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yu Xia
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lingyan Zhu
- Department of Endocrinology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Enjun Lei
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Joshua Kaplan
- Department of Urology, Temple University Hospital, Philadelphia, PA, United States
| | - Yaoliang Deng
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- *Correspondence: Gongxian Wang, ; Daniel Eun, ; Yaoliang Deng,
| | - Daniel Eun
- Department of Urology, Temple University Hospital, Philadelphia, PA, United States
- *Correspondence: Gongxian Wang, ; Daniel Eun, ; Yaoliang Deng,
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- *Correspondence: Gongxian Wang, ; Daniel Eun, ; Yaoliang Deng,
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18
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Hue JJ, Ahorukomeye P, Bingmer K, Drapalik L, Ammori JB, Wilhelm SM, Rothermel LD, Towe CW. A comparison of robotic and laparoscopic minimally invasive adrenalectomy for adrenal malignancies. Surg Endosc 2021; 36:5374-5381. [PMID: 34724582 DOI: 10.1007/s00464-021-08827-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although guidelines recommend open adrenalectomy for most resectable adrenal malignancies, minimally invasive adrenalectomies are performed. Robotic adrenalectomies have become more popular recently, but there is a paucity of literature comparing laparoscopic and robotic resections. METHODS Patients who underwent a planned minimally invasive adrenalectomy for adrenal malignancies (adrenocortical carcinoma, malignant pheochromocytoma, other carcinoma) were identified in the National Cancer Database. The primary outcome was the conversion rate from minimally invasive to open. Other post-operative outcomes and survival were compared. RESULTS 416 patients (76.5%) underwent a laparoscopic adrenalectomy and 128 (23.5%) underwent a robotic operation. Demographics and clinical characteristics were similar. Approximately 19% of tumors resected by a minimally invasive approach were > 10 cm. The intra-operative conversion rate was decreased among robotic adrenalectomies relative to laparoscopic on univariate (7.8% vs. 18.3%, p = 0.005) and multivariable (odds ratio 0.39, p = 0.01) analyses. Using marginal standardization, there was a stepwise increase in the conversion rate as tumor size increased (< 5, 5-10, > 10 cm) for laparoscopic (7.5%, 18.0%, 33.2%) and robotic (3.1%, 8.3%, 17.3%) adrenalectomies. Operations which required conversion had a greater margin positivity rate, greater length of stay, and an association with poor overall survival. CONCLUSION In contrast to most clinical guidelines, minimally invasive adrenalectomies are being performed on large malignant tumors. A laparoscopic approach was associated with a greater conversion rate and subsequent poor outcomes. If a surgeon is not planning an open adrenalectomy, but adrenal malignancy is a possibility, robotic adrenalectomy may be the preferred approach for resectable adrenal tumors.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - Peter Ahorukomeye
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - Lauren Drapalik
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - Scott M Wilhelm
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - Luke D Rothermel
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - Christopher W Towe
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA.
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Hormonally Active Adrenal tumors; Challenges and Outcomes for Different Surgical Approaches. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:325-332. [PMID: 34712073 PMCID: PMC8526223 DOI: 10.14744/semb.2021.13845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/18/2021] [Indexed: 11/20/2022]
Abstract
Objective: The aim of this study is to compare the intraoperative and short-term outcomes of different surgical approaches for hormone active and non-functional adrenal masses. Methods: The data of 206 patients who underwent adrenal gland surgery in our clinic between 2012 and 2020 were retrospectively analyzed. Pre-operative outpatient clinic records of the patients, imaging methods, laboratory results and surgery records, operation time (OT), amount of bleeding, duration of hospital stay, and complications were evaluated. Patients were divided into two groups as those with non-functional mass (n=80) and those with hormoneactive mass (n=126). Results: The median age of the patients was 52 (range 19–83) and 77.2% of them were female. Tumor size was larger in hormone active group (p=0.311), and the difference was more pronounced in the pheochromocytoma subgroup (p=0.088). The rate of transition to open surgery was similar in both groups (0.959), and no conversion to laparoscopy or conventional open surgery was performed in robotic cases. The duration of surgery (p=0.669), mean amount of blood loss (p=0.834), and mean hospital stay (p=0.195) were also similar between the two groups. Intraoperative and post-operative complications were similar between two groups (p=0.573 and p=0.415, respectively). Considering the subgroup analysis of the patients in hormone active group; the duration of hospital stay was longer in patients with Cushing syndrome (p=0.001), while there was no difference in OT and estimated blood loss between patients who were operated for Conn, Cushing, and pheochromocytoma (p=0.086 and p=0.099; respectively). Conclusion: Surgical results of hormone active adrenal masses were found to be similar to non-functional masses. Although the hormonal condition of the mass does not change the difficulty level of the surgical procedure, it may be recommended that the robotic approach be preferred to facilitate manipulation in these masses.
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20
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Bhambhvani HP, Daneshvar MA, Peterson DJ, Ball MW. Partial versus total adrenalectomy for pheochromocytoma: a population-based comparison of outcomes. Int Urol Nephrol 2021; 53:2485-2492. [PMID: 34623590 DOI: 10.1007/s11255-021-03004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The literature assessing outcomes of partial adrenalectomy (PA) among patients with pheochromocytoma patients is largely limited to isolated, single-institution series. We aimed to perform a population-level comparison of outcomes between patients undergoing PA versus those undergoing total adrenalectomy (TA). METHODS The Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) was queried to identify adults with pheochromocytoma who underwent either PA or TA. Survival was assessed using multivariable Cox proportional hazards regression, Fine and Gray competing-risks regression, propensity score matching, Kaplan-Meier analysis, and cumulative incidence plots. RESULTS 286 patients (PA: 101, TA: 185) were included in this study. As compared to those undergoing TA, patients undergoing PA had fewer tumors ≥ 8 cm in size (28.7% versus 42.7%, p = 0.048) and were more likely to have localized disease (61.4% versus 44.3%, p = 0.01). In multivariable analysis, patients undergoing PA demonstrated similar all-cause mortality (HR = 0.71, 95% CI 0.44-1.14, p = 0.16) and cancer-specific mortality (HR = 0.64, 95% CI 0.35-1.17, p = 0.15) compared to those who underwent TA. Following 1:1 propensity score matching, Kaplan-Meier analysis revealed no difference in overall survival between PA and TA groups (p = 0.26) nor was there a difference in the cumulative incidence of cancer-specific mortality (p = 0.29). CONCLUSIONS In this first population-level comparison of outcomes among patients with pheochromocytoma undergoing PA and those undergoing TA, we found no long-term differences in any survival metric between groups. PA circumvents the need for lifelong corticoid replacement therapy and remains a promising option for patients with bilateral or recurrent pheochromocytoma.
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Affiliation(s)
- Hriday P Bhambhvani
- Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
| | - Michael A Daneshvar
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dylan J Peterson
- Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Mark W Ball
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Urabe F, Kimura S, Iwatani K, Takahashi K, Ito K, Tashiro K, Tsuzuki S, Miki J, Kimura T, Furuta N, Egawa S. Risk Factors for Perioperative Hemodynamic Instability in Pheochromocytoma: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10194531. [PMID: 34640549 PMCID: PMC8509814 DOI: 10.3390/jcm10194531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: To evaluate the risk factors of perioperative hemodynamic instability in pheochromocytoma, we conducted a systematic search of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analysis. Methods: In April 2021, we systematically searched PubMed, the Cochrane library, and Scopus for relevant studies on the risk factors of perioperative hemodynamic instability of adrenalectomy in patients with pheochromocytoma, and we subjected the findings from those studies to formal meta-analysis. Results: Our systematic review identified 14 studies involving 1725 patients, of which nine studies with 967 patients were eligible for meta-analysis. The results of meta-analysis showed that tumor size (odds ratio (OR): 1.14 for each increased cm, 95% confidence interval (CI) 1.03–1.26, z = 2.57) and urinary norepinephrine (OR, 1.51: 95% CI 1.26–1.81; z = 4.50) were most closely associated with the occurrence of perioperative hemodynamic instability. Conclusion: These findings suggest that tumor size and urinary norepinephrine are important predictors and risk factors for perioperative hemodynamic instability in adrenalectomy for pheochromocytoma. Such findings may be of value to surgeons and anesthesiologists when considering or preparing for this procedure.
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Affiliation(s)
- Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
- Correspondence:
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
- Department of Urology, The Jikei University Kashiwa Hospital, Chiba 277-8567, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
| | - Kazuhiro Takahashi
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
| | - Kagenori Ito
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
- Department of Urology, The Jikei University Kashiwa Hospital, Chiba 277-8567, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
| | - Nozomu Furuta
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo 105-8461, Japan; (S.K.); (K.I.); (K.T.); (K.I.); (K.T.); (S.T.); (J.M.); (T.K.); (N.F.); (S.E.)
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22
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Alberici L, Paganini AM, Ricci C, Balla A, Ballarini Z, Ortenzi M, Casole G, Quaresima S, Di Dalmazi G, Ursi P, Alfano MS, Selva S, Casadei R, Ingaldi C, Lezoche G, Guerrieri M, Minni F, Tiberio GAM. Development and validation of a preoperative "difficulty score" for laparoscopic transabdominal adrenalectomy: a multicenter retrospective study. Surg Endosc 2021; 36:3549-3557. [PMID: 34402981 PMCID: PMC9001553 DOI: 10.1007/s00464-021-08678-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/07/2021] [Indexed: 12/14/2022]
Abstract
Background A difficulty score for laparoscopic adrenalectomy (LA) is lacking in the literature. A retrospective cohort study was designed to develop a preoperative “difficulty score” for LA. Methods A multicenter study was conducted involving four Italian tertiary centers for adrenal disease. The population was randomly divided into two subsets: training group and validation one. A multicenter study was undertaken, including 964 patients. Patient, adrenal lesion, surgeon’s characteristics, and the type of procedure were studied as potential predictors of target events. The operative time (pOT), conversion rate (cLA), or both were used as indicators of the difficulty in three multivariate models. All models were developed in a training cohort (70% of the sample) and validated using 30% of patients. For all models, the ability to predict complicated postoperative course was reported describing the area under the curve (AUCs). Logistic regression, reporting odds ratio (OR) with p-value, was used. Results In model A, gender (OR 2.04, p = 0.001), BMI (OR 1.07, p = 0.002), previous surgery (OR 1.29, p = 0.048), site (OR 21.8, p < 0.001) and size of the lesion (OR 1.16, p = 0.002), cumulative sum of procedures (OR 0.99, p < 0.001), extended (OR 26.72, p < 0.001) or associated procedures (OR 4.32, p = 0.015) increased the pOT. In model B, ASA (OR 2.86, p = 0.001), lesion size (OR 1.20, p = 0.005), and extended resection (OR 8.85, p = 0.007) increased the cLA risk. Model C had similar results to model A. All scores obtained predicted the target events in validation cohort (OR 1.99, p < 0.001; OR 1.37, p = 0.007; OR 1.70, p < 0.001, score A, B, and C, respectively). The AUCs in predicting complications were 0.740, 0.686, and 0.763 for model A, B, and C, respectively. Conclusion A difficulty score based on both pOT and cLA (Model C) was developed using 70% of the sample. The score was validated using a second cohort. Finally, the score was tested, and its results are able to predict a complicated postoperative course. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08678-6.
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Affiliation(s)
- Laura Alberici
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alessandro M Paganini
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Claudio Ricci
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
- Policlinico S.Orsola-Malpighi, Alma Mater Studiorum-Università di Bologna, Via Massarenti n.9, 40138, Bologna, Italy.
| | - Andrea Balla
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Zeno Ballarini
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Monica Ortenzi
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Giovanni Casole
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Silvia Quaresima
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Guido Di Dalmazi
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Pietro Ursi
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marie Sophie Alfano
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Saverio Selva
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Riccardo Casadei
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Carlo Ingaldi
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Giovanni Lezoche
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Mario Guerrieri
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Francesco Minni
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Guido Alberto Massimo Tiberio
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
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23
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Surgical Management of Adrenocortical Carcinoma: Current Highlights. Biomedicines 2021; 9:biomedicines9080909. [PMID: 34440112 PMCID: PMC8389566 DOI: 10.3390/biomedicines9080909] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Adrenocortical carcinoma (ACC) is a rare tumor, often discovered at an advanced stage and associated with poor prognosis. Treatment is guided by staging according to the European Network for the Study of Adrenal Tumors (ENSAT) classification. Surgery is the treatment of choice for ACC. The aim of this review is to provide a complete overview on surgical approaches and management of adrenocortical carcinoma. METHODS This comprehensive review has been carried out according to the PRISMA statement. The literature sources were the databases PubMed, Scopus and Cochrane Library. The search thread was: ((surgery) OR (adrenalectomy)) AND (adrenocortical carcinoma). RESULTS Among all studies identified, 17 were selected for the review. All of them were retrospective. A total of 2498 patients were included in the studies, of whom 734 were treated by mini-invasive approaches and 1764 patients were treated by open surgery. CONCLUSIONS Surgery is the treatment of choice for ACC. Open adrenalectomy (OA) is defined as the gold standard. In recent years laparoscopic adrenalectomy (LA) has gained more popularity. No significant differences were reported for overall recurrence rate, time to recurrence, and cancer-specific mortality between LA and OA, in particular for Stage I-II. Robotic adrenalectomy (RA) has several advantages compared to LA, but there is still a lack of specific documentation on RA use in ACC.
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24
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Clinical Judgment and Experience Remain Critical Factors in the Safety of Minimally Invasive Adrenalectomy: Commentary on "Outpatient Adrenalectomy: A Framework for Assessment and Institutional Protocol". Ann Surg 2021; 275:e543. [PMID: 34225291 DOI: 10.1097/sla.0000000000005037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Tavares WM, de Franca SA, Vasconcelos AS, Parra DSL, Araújo SRR, Teixeira MJ. Robotic and standard surgical intervention as adjunct therapies for retroperitoneal ganglioneuroma resection: a case report. BMC Surg 2021; 21:143. [PMID: 33740932 PMCID: PMC7980646 DOI: 10.1186/s12893-021-01146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ganglioneuroma (GN) is ranked by the International Neuroblastoma Pathology Classification as a benign tumor. It can occur anywhere along the sympathetic nerve chain and surgical excision is the treatment of choice. Case presentation An 18-year-old female patient sought medical assistance after 6 months of constant dorsal and back pain radiating from the thoracic region to the right abdominal flank. Magnetic resonance imaging revealed a solid nodular lesion with heterogeneous post-contrast enhancement and lobulated contours, centered on the right foramina of D12–L1, with a projection to the intracanal space, which compressed and laterally displaced the dural sac and had a right paravertebral extension between the vertebral bodies of D11 and superior aspect of L2. Ganglioneuroma was diagnosed using immunohistochemical analysis. It was decided to use a surgical approach in two stages: robot assisted for the anterior/retroperitoneal mass and a posterior hemilaminectomy/microsurgical approach to attempt total resection, avoiding the traditional anterior thoracoabdominal surgical incision and optimizing the patient’s postoperative outcomes. No postoperative adverse events were noted, and the patient was discharged on postoperative day 5. Conclusion This retroperitoneal GN presentation was peculiar because it originated at the D12 nerve root, which extended to the retroperitoneal space and inside the spinal canal. We hope that our case report can assist future decisions in similar circumstances. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01146-x.
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Affiliation(s)
- Wagner M Tavares
- Department of Research of IPSPAC, Instituto Paulista de Saúde Para Alta Complexidade, 199 Padre Anchieta Avenue, Room 2, Jardim, Santo André, SP, 09090-710, Brazil.,Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil
| | - Sabrina Araujo de Franca
- Department of Research of IPSPAC, Instituto Paulista de Saúde Para Alta Complexidade, 199 Padre Anchieta Avenue, Room 2, Jardim, Santo André, SP, 09090-710, Brazil.
| | - Amsterdam S Vasconcelos
- Surgical Oncology Department, Hospital Santa Catarina, 200 Paulista Avenue, Bela Vista, São Paulo, SP, 01310-000, Brazil
| | - David S L Parra
- Department of Research of IPSPAC, Instituto Paulista de Saúde Para Alta Complexidade, 199 Padre Anchieta Avenue, Room 2, Jardim, Santo André, SP, 09090-710, Brazil
| | - Sergio R R Araújo
- LabPac, Laboratório Anatomia Patológica Imuno-Histoquímica Citopatologica, 75 Calixto da Mota Street, Vila Mariana, São Paulo, SP, 04117-100, Brazil
| | - Manoel J Teixeira
- Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil
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26
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Pisarska-Adamczyk M, Zawadzka K, Więckowski K, Przęczek K, Major P, Wysocki M, Małczak P, Pędziwiatr M. Risk factors for hemodynamic instability during laparoscopic pheochromocytoma resection: a retrospective cohort study. Gland Surg 2021; 10:892-900. [PMID: 33842234 DOI: 10.21037/gs-20-783] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Adrenalectomy for pheochromocytoma, a rare catecholamine-secreting tumour, is a challenging procedure because of the high risk of intraoperative hemodynamic instability, which can cause life-threatening complications. Our study aimed to identify predictive factors for hemodynamic instability during pheochromocytoma resection as well as to assess the risk factors for postoperative morbidity. Methods Data of 96 patients, who underwent laparoscopic adrenalectomy were analysed retrospectively. Hemodynamic instability was defined as an occurrence of both intraoperative episodes of systolic blood pressure above 160 mmHg and vasoactive (vasodilators or vasoconstrictors) drug administration. Patients were divided into two groups: one which met both criteria, and another one without hemodynamic instability-42 (43.8%) and 54 (56.2%) respectively. Results The mean tumour size was 4.5±2.0 cm. 86 patients had a sporadic pheochromocytoma and 10 (10.4%) had a familial disease. Sixty-three patients were preoperatively treated with nonselective blockers and 33 patients with selective blockers. Mean operative time was 98.7±41.7 min. and mean intraoperative blood loss was 165.7±381.2 mL. In 26% of patients, postoperative complications occurred. The median length of hospital stay was 3 days. The multivariate logistic regression model showed that the size of adrenal tumour and diabetes were significant factors of hemodynamic instability. Intraoperative use of vasopressors was an independent risk factor for both all-cause and cardiovascular morbidity. Conclusions Adrenal tumour size and diabetes were associated with hemodynamic instability during pheochromocytoma resection. The only risk factor for complications in our group was intraoperative necessity to use vasopressors.
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Affiliation(s)
- Magdalena Pisarska-Adamczyk
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Karolina Zawadzka
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Więckowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Przęczek
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
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27
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Cancer risk in adrenalectomy: are adrenal lesions equal or more than 4 cm a contraindication for laparoscopy? Surg Endosc 2021; 36:1131-1142. [PMID: 33650006 PMCID: PMC8758647 DOI: 10.1007/s00464-021-08380-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/09/2021] [Indexed: 12/02/2022]
Abstract
Background Some authors consider adrenal lesions size of less than 4 cm as a positive cut-off limit to set the indications for minimally invasive surgery due to a lower risk of malignancy. Aim of this study is to report the risk of cancer for adrenal lesions measuring 4 cm or more in diameter, assessed as benign at preoperative workup (primary outcome), and to evaluate the feasibility and safety of laparoscopic adrenalectomy (LA) in these cases (secondary outcome). Methods From January 1994 to February 2019, 579 patients underwent adrenalectomy. Fifty patients with a preoperative diagnosis of primary adrenal cancer or metastases were excluded. The remaining 529 patients were included and divided in five subgroups based on adrenal lesion size at definitive histology: group A, 4–5.9 cm (137 patients); group B, 6–7.9 cm (64 patients); group C, 8–9.9 cm (13 patients); group D, ≥ 10 cm (11 patients); group E, < 4 cm (304 patients). Each group was further divided based on diagnosis of benign or malignant lesions at definitive histology. Results Four (2.9%) malignant lesions were observed in group A, 5 (7.8%) in group B, 2 (15.4%) in Groups C and D (18.2%) and 13 (4.3%) in Group E. Comparing the cancer risk among the groups, no statistically significant differences were observed. Operative time increased with increasing lesion size. However, no statistically significant differences were observed between benign and malignant lesions in each group comparing operative time, conversion and complication rates, postoperative hospital stay and mortality rate. Conclusions Adrenal lesions measuring 4 cm or more in diameter are not a contraindication for LA neither in terms of cancer risk nor of conversion and morbidity rates, even if the operative time increases with increasing adrenal lesion diameter. Further prospective studies with a larger number of patients are required to draw definitive conclusions.
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28
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Hue JJ, Bingmer K, Zhao H, Ammori JB, Wilhelm SM, Towe CW, Rothermel LD. Reassessing the impact of tumor size on operative approach in adrenocortical carcinoma. J Surg Oncol 2021; 123:1238-1245. [PMID: 33577722 DOI: 10.1002/jso.26418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is often a contraindication to minimally invasive adrenalectomy (MIA). We used an administrative data set to analyze postoperative outcomes. We hypothesized that small tumors would have better short- and long-term outcomes, independent of the operative approach. METHODS The National Cancer Database (2010-2016) identified patients with ACC who underwent adrenalectomy. Tumors were grouped: <5 cm (n = 125), 5-10 cm (n = 431), and >10 cm (n = 443). The primary and secondary outcomes were margin positivity and overall survival, respectively. RESULTS Nine hundred and ninety-nine patients were analyzed: 37% MIA and 63% open adrenalectomy (OA). As the size increased, the rate of attempted MIA decreased. Larger tumors were associated with conversion to open. Although tumors with local invasion and those which required conversion to open were associated with an increased likelihood of a positive margin, tumor size was not. Although "complete" MIA (vs. OA) and tumor size were not associated with differences in survival, conversion (HR = 1.83, p = .02), positive margins (HR = 1.54, p = .01), and local invasion (HR = 1.84, p < .001) were associated with poor survival. CONCLUSION Positive margins are associated with poor survival in ACC. Tumors ≥ 5 cm were associated with an increased conversion rate and subsequent increase in margin positivity. MIA may be considered for select patients with small tumors but adequate oncologic resection is critical.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Heming Zhao
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Scott M Wilhelm
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Christopher W Towe
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luke D Rothermel
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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29
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Prakobpon T, Santi-Ngamkun A, Usawachintachit M, Ratchanon S, Sowanthip D, Panumatrassamee K. Laparoscopic transperitoneal adrenalectomy in the large adrenal tumor from single center experience. BMC Surg 2021; 21:68. [PMID: 33522915 PMCID: PMC7849150 DOI: 10.1186/s12893-021-01080-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background The role of laparoscopic adrenalectomy (LA) in a large adrenal tumor is controversial due to the risk of malignancy and technical difficulty. In this study, we compared the perioperative outcomes and complications of LA on large (≥ 6 cm) and (< 6 cm) adrenal tumors. Methods We retrospectively reviewed all clinical data of patients who underwent unilateral transperitoneal LA in our institution between April 2000 and June 2019. Patients were classified by tumor size into 2 groups. Patients in group 1 had tumor size < 6 cm (n = 408) and patient in group 2 had tumor size ≥ 6 cm (n = 48). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups. Results Patients in group 2 were significant older (p = 0.04), thinner (p = 0.001) and had lower incident of hypertension (p = 0.001), with a significantly higher median operative time (75 vs 120 min), estimated blood loss (20 vs 100 ml), transfusion rate (0 vs 20.8%), conversion rate (0.25 vs 14.6%) and length of postoperative stays ( 4 vs 5.5 days) than in group 2 (all p < 0.001). Group 2 patients also had significantly higher frequency of intraoperative complication (4.7 vs 31.3%; adjust Odds Ratio [OR] = 9.67 (95% CI 4.22–22.17), p-value < 0.001) and postoperative complication (5.4 vs 31.3%; adjust OR = 5.67 (95% CI 2.48–12.97), p-value < 0.001). Only eight (1.8%) major complications occurred in this study. The most common pathology in group 2 patient was pheochromocytoma and metastasis. Conclusions Laparoscopic transperitoneal adrenalectomy in large adrenal tumor ≥ 6 cm is feasible but associated with significantly worse intraoperative complications, postoperative complications, and recovery. However, most of the complications were minor and could be managed conservatively. Careful patient selection with the expert surgeon in adrenal surgery is the key factor for successful laparoscopic surgery in a large adrenal tumor. Trial registration: This study was retrospectively registered in the Thai Clinical Trials Registry on 02/03/2020. The registration number was TCTR20200312004.
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Affiliation(s)
- Thanasit Prakobpon
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Apirak Santi-Ngamkun
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Manint Usawachintachit
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Supoj Ratchanon
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Dutsadee Sowanthip
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Kamol Panumatrassamee
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
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Al-Jalabneh T, Al-Shawabkeh O, Al-Gwairy I, Abu-Zeitoun O, Al-Njadat I, Al-Soudi M, Zarour A. Laparoscopic Versus Open Adrenalectomy: a Retrospective Comparative Study. Med Arch 2021; 75:41-44. [PMID: 34012198 PMCID: PMC8116067 DOI: 10.5455/medarh.2021.75.41-44] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Laparoscopic Adrenalectomy (LA) has rapidly become the gold standard in management of adrenal tumors as it has been found to be associated with better cosmoses, shorter hospital stay and rapid convalescence. OBJECTIVE The aim of this study was to compare laparoscopic and open approach to adrenal glands in terms of operative time, hospital stay, indications and blood loss at a tertiary medical center in Jordan. METHODS A retrospective comparative study which included all patients who underwent adrenalectomy (open or laparoscopic) from 2005 to 2015 at King Hussein Medical Center (KHMC). Patients' demographics ,outcomes and essential study variables were extracted from patients' files. Data analysis was performed using SPSS17 and Stata 10. RESULTS One hundred and three patients (mean age 44.9 years) were included, 90.2% of them underwent laparoscopic adrenalectomy. The size of the tumors ranged from 2 to 17 cm (mean 6.6 cm).The operative time, blood loss and hospital stay were significantly less in the laparoscopic group (P value <0.001). Patients in Open group had a significantly higher risk of incomplete excision of the tumors (P value=0.020). CONCLUSION Laparoscopic adrenalectomy is associated with decreased operative time, blood loss and hospital stay compared to open approach. Tumor size and its malignant potential should be no more regarded as an absolute contraindication to laparoscopic adrenal surgery.
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Affiliation(s)
- Talal Al-Jalabneh
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Omar Al-Shawabkeh
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Ibrahim Al-Gwairy
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Omar Abu-Zeitoun
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Ismaieel Al-Njadat
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Majdi Al-Soudi
- Breast and Oncology Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
| | - Ahmad Zarour
- Laparoscopic and Bariatric Surgery, Department of Surgery, Royal Medical Services, Amman, Jordan
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Piccoli M, Pecchini F, Serra F, Nigro C, Colli G, Gozzo D, Zirilli L, Madeo B, Rochira V, Mullineris B. Robotic Versus Laparoscopic Adrenalectomy: Pluriannual Experience in a High-Volume Center Evaluating Indications and Results. J Laparoendosc Adv Surg Tech A 2021; 31:375-381. [PMID: 33450160 PMCID: PMC8060876 DOI: 10.1089/lap.2020.0839] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Robotic adrenalectomy offers several clinical benefits if compared with laparoscopic adrenalectomy; however, its superiority is still under debate. The aim of this study was the investigation of differences between the two techniques, and a comparison when approaching right or left side adrenal lesions was further conducted. Materials and Methods: All patients undergoing laparoscopic and robotic unilateral adrenalectomy at our institution from January 2006 to December 2019 were collected and retrospectively analyzed. Statistical analysis was conducted; differences between the two cohorts were reported. Results: A total of 160 cases were included (84 patients in laparoscopic adrenalectomy-group [LA-g] 76 cases in robotic adrenalectomy-group [RA-g]). The groups were homogeneous for demographic data. No intraoperative complications were reported; mean amount of intraoperative blood loss was comparable. No cases of conversion to open surgery were required. RA-g presented a longer operative time than LA-g for right adrenalectomy (P = .05), no differences were noted for left side (P = .187). Overall morbidity was 21% for LA-g and 10.5% for RA-g (P = .087), with an inferior rate of surgical complications for RA-g (P = .024), and for robotic left adrenalectomy than robotic right procedure (P = .03). Length of hospital stay was shorter for RA-g (P = .005). Conclusions: Robotic adrenalectomy presents similar outcomes as laparoscopic approach with some benefits for selected cases. Left adrenal lesions seem to receive greater advantages from robotic technique. Large randomized controlled trials are required to determine the role of robotic adrenal surgery and if the indication can be standardized based on the laterality of adrenal procedure.
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Affiliation(s)
- Micaela Piccoli
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Francesca Pecchini
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Francesco Serra
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Casimiro Nigro
- General Surgery Department, Torvergata University, Rome, Italy
| | - Giovanni Colli
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Davide Gozzo
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
| | - Lucia Zirilli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Mullineris
- Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena, Italy
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32
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Seetharam Bhat KR, Moschovas MC, Onol FF, Rogers T, Roof S, Patel VR, Schatloff O. Robotic renal and adrenal oncologic surgery: A contemporary review. Asian J Urol 2021; 8:89-99. [PMID: 33569275 PMCID: PMC7859360 DOI: 10.1016/j.ajur.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023] Open
Abstract
Robot-assisted surgery has evolved over time. Radical nephrectomy with inferior vena cava thrombectomy is feasible and safe for level I, II and III thrombus in high volume centers. Though it is feasible for level IV thrombus, this procedure needs a multi-departmental co-operation. However, the safety of robot-assisted procedures in this subset is still unknown. Robot-assisted partial nephrectomy has been universally approved and found oncologically safe. Robotic adrenalectomy has been increasingly utilized for select cases, especially in bilateral tumors and for retroperitoneal adrenalectomy.
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Affiliation(s)
| | | | - Fikret Fatih Onol
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Travis Rogers
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Shannon Roof
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Vipul R. Patel
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Oscar Schatloff
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
- Sudmedica Health, Chile
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33
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St-Amour P, Djafarrian R, Zingg T, La Rosa S, Demartines N, Matter M. Laparoscopic resection of an adrenal oncocytic neoplasm: Report of a case and review of the literature. Int J Surg Case Rep 2020; 76:305-309. [PMID: 33068855 PMCID: PMC7567174 DOI: 10.1016/j.ijscr.2020.09.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/10/2022] Open
Abstract
Oncocytic adrenal neoplasms are rare and mostly benign lesions. Preoperative determination of malignancy remains difficult. Surgical excision planification is based on preoperative investigations.
Introduction Oncocytic adrenal neoplasms are rare and mostly benign lesions. Available literature supports indication for a surgical resection, but criteria to predict aggressive behavior are unreliable, thus making decision of surgical approach (laparotomy versus laparoscopy), and extent of resection, difficult to define. Presentation of case This is the case of a 46-year-old male, with an incidental finding of a 10 cm asymptomatic tumor in the left adrenal gland identified by MRI, performed in the setting of the initial assessment of liver steatosis. Adrenal hormone levels were in the normal range, thus, a CT-guided needle biopsy was performed and showed an adrenocortical oncocytic neoplasm. A laparoscopic left adrenalectomy was performed sparing the adjacent left kidney. Histological examination of the resected tumor showed a 10 cm oncocytic adrenocortical neoplasm of uncertain malignant potential with negative resection margins. A follow-up MRI was scheduled at six months after surgery, and no recurrence was found. Conclusions Although rare, oncocytic neoplasms should be included in the differential diagnosis of adrenal “incidentalomas”. Determination of their malignant potential is difficult in the preoperatory setting. Final diagnosis is based on histological analysis of the whole surgical specimen. Laparoscopic complete excision with negative resection margins is feasible and safe.
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Affiliation(s)
- P St-Amour
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - R Djafarrian
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - T Zingg
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - S La Rosa
- Institute of Pathology, University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - M Matter
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
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Perysinakis I, Aggeli C, Kaltsas G, Zografos GN. Adrenal-sparing surgery: current concepts on a theme from the past. Hormones (Athens) 2020; 19:317-327. [PMID: 32388629 DOI: 10.1007/s42000-020-00202-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/07/2020] [Indexed: 12/14/2022]
Abstract
Adrenal insufficiency represents a debilitating condition which mandates lifelong steroid replacement and which is associated with significant long-term morbidity, due to either inadequate or excessive replacement. The concept of preserving healthy cortical tissue by means of partial adrenalectomy has evolved as a means of avoiding the detrimental consequences of adrenal insufficiency. The advent of advanced technology in adrenal surgery has greatly facilitated the performance of partial adrenalectomy, enabling utilization of this method in an increasing number of endocrine diseases. Hereditary pheochromocytoma, Conn's syndrome, Cushing's syndrome, and non-functional adrenal masses represent the current indications for partial adrenalectomy, although the specific circumstances under which adrenal-sparing surgery should be proposed are still debatable. Partial adrenalectomy can be achieved by all types of minimally invasive surgery. In the absence of randomized, prospective, controlled studies designed to compare laparoscopic, retroperitoneoscopic, and robot-assisted partial adrenalectomy, none of these techniques has as yet been proven to be the gold standard for adrenal-sparing surgery. Apart from indications for surgery, results of surgery, and different types of partial adrenalectomy, controversial topics addressed in this review article include technical aspects such as the volume of residual adrenal tissue needed, ligation of adrenal vein, and means of tumor identification. Discussion of these controversial topics represents an attempt to define the role of partial adrenalectomy in modern adrenal surgery.
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Affiliation(s)
- Iraklis Perysinakis
- Third Surgical Department of Surgery, General Hospital "G. Gennimatas", Athens, Greece.
| | - Ch Aggeli
- Third Surgical Department of Surgery, General Hospital "G. Gennimatas", Athens, Greece
| | - Gr Kaltsas
- First Department of Propaedeutic Internal Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - G N Zografos
- Third Surgical Department of Surgery, General Hospital "G. Gennimatas", Athens, Greece
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35
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Berends AMA, Kerstens MN, Lenders JWM, Timmers HJLM. Approach to the Patient: Perioperative Management of the Patient with Pheochromocytoma or Sympathetic Paraganglioma. J Clin Endocrinol Metab 2020; 105:5868468. [PMID: 32726444 DOI: 10.1210/clinem/dgaa441] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/06/2020] [Indexed: 02/04/2023]
Abstract
Pheochromocytomas and sympathetic paraganglioma (PPGL) are rare chromaffin cell tumors originating in the adrenal medulla and sympathetic paraganglia, respectively, which share the capacity to synthesize and release catecholamines. The incidence of PPGL has increased in recent years. Surgical resection is the only curative treatment for PPGL. Management of patients with PPGL is complex and should be done by a specialized multidisciplinary team in centers with broad expertise. Surgical resection of a PPGL is a high-risk procedure for which optimal pretreatment with antihypertensive drugs is required in combination with state-of-the-art surgical procedures and anesthesiological techniques. In this article we discuss the underlying evidence and the pros and cons of presurgical medical preparation. Finally, the areas of uncertainty and controversies in this field are addressed.
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Affiliation(s)
- Annika M A Berends
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel N Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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36
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Lenders JWM, Kerstens MN, Amar L, Prejbisz A, Robledo M, Taieb D, Pacak K, Crona J, Zelinka T, Mannelli M, Deutschbein T, Timmers HJLM, Castinetti F, Dralle H, Widimský J, Gimenez-Roqueplo AP, Eisenhofer G. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens 2020; 38:1443-1456. [PMID: 32412940 PMCID: PMC7486815 DOI: 10.1097/hjh.0000000000002438] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
: Phaeochromocytoma and paraganglioma (PPGL) are chromaffin cell tumours that require timely diagnosis because of their potentially serious cardiovascular and sometimes life- threatening sequelae. Tremendous progress in biochemical testing, imaging, genetics and pathophysiological understanding of the tumours has far-reaching implications for physicians dealing with hypertension and more importantly affected patients. Because hypertension is a classical clinical clue for PPGL, physicians involved in hypertension care are those who are often the first to consider this diagnosis. However, there have been profound changes in how PPGLs are discovered; this is often now based on incidental findings of adrenal or other masses during imaging and increasingly during surveillance based on rapidly emerging new hereditary causes of PPGL. We therefore address the relevant genetic causes of PPGLs and outline how genetic testing can be incorporated within clinical care. In addition to conventional imaging (computed tomography, MRI), new functional imaging approaches are evaluated. The novel knowledge of genotype-phenotype relationships, linking distinct genetic causes of disease to clinical behaviour and biochemical phenotype, provides the rationale for patient-tailored strategies for diagnosis, follow-up and surveillance. Most appropriate preoperative evaluation and preparation of patients are reviewed, as is minimally invasive surgery. Finally, we discuss risk factors for developing metastatic disease and how they may facilitate personalised follow-up. Experts from the European Society of Hypertension have prepared this position document that summarizes the current knowledge in epidemiology, genetics, diagnosis, treatment and surveillance of PPGL.
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Affiliation(s)
- Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Michiel N Kerstens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laurence Amar
- Unité d'Hypertension Artérielle, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université de Paris-PARCC, INSERM, Paris, France
| | | | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Program, Spanish National Cancer Research Centre (CNIO), and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - David Taieb
- Department of Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Joakim Crona
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Tomáš Zelinka
- Center for Hypertension, 3rd Department of Medicine, Division of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Massimo Mannelli
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Timo Deutschbein
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederic Castinetti
- Aix-Marseille Université, Department of Endocrinology, Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille Medical Genetics (MMG), et Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Jřri Widimský
- Center for Hypertension, 3rd Department of Medicine, Division of Endocrinology and Metabolism, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Anne-Paule Gimenez-Roqueplo
- Assistance Publique-Hôpitaux de Paris, AP-HP, Hôpital Européen Georges Pompidou, Service de Génétique, Université de Paris, PARCC, INSERM, Paris, France
| | - Graeme Eisenhofer
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Cicek MC, Gunseren KO, Senol K, Vuruskan H, Yavascaoglu I. Is 6 cm Diameter an Upper Limit for Adrenal Tumors to Perform Laparoscopic Adrenalectomy? J Laparoendosc Adv Surg Tech A 2020; 31:301-305. [PMID: 32716248 DOI: 10.1089/lap.2020.0505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: We aimed to compare the results of patients who underwent laparoscopic adrenalectomy (LA) for masses ≥6 cm versus <6 cm in diameter in our tertiary referral university hospital. Materials and Methods: Three hundred thirty consecutive patients were divided into two groups according to tumor size (≥6 and <6 cm in diameter). Demographic variables, body mass index (BMI), lesion localization (right/left), tumor diameter, pathological diagnosis and surgical outcomes, including operation time, estimated blood loss (EBL), conversion to open surgery, complications, and length of hospital stay were compared between groups. Results: Between February 2008 and March 2020, 53 patients (29 male-24 female) with ≥6 cm (L group) adrenal tumor and 277 patients (105 male-172 female) with <6 cm tumor (S group) underwent transperitoneal LA. One hundred sixty-eight (50.9%) tumors localized on the left side. In L group mean tumor size in female and male patients was 87.5 ± 40.8 mm (range 50-225 mm) and 67.3 ± 18.4 mm (range 10-100 mm), respectively (P < .05). Age, American Society of Anesthesiology scores, BMI, and mean operation time were similar between groups (P > .05). Postoperative complications were more often in L group (P = .005). EBL in group L and group S was 86 ± 70.4 mL (range 10-500 mL) and 55 ± 44.2 mL (range 10-300 mL), respectively (P = .003). Length of hospital stay in group L and group S was 3.7 ± 3.5 days (range 1-26) and 3 ± 1.6 days (range 1-9), respectively (P = .086). Significant variables in multivariate analysis, including gender (male), EBL, and postoperative complication rate, were entered into multivariate regression analysis, which presented that EBL and postoperative complication rates were independent significants for the L group. Conclusion: Six centimeters should not be considered as an upper limit of transperitoneal lateral LA and may be safely performed in centers with experience. Further studies are needed to confirm our data.
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Affiliation(s)
| | - Kadir Omur Gunseren
- Department of Urology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Kazım Senol
- Department of General Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Hakan Vuruskan
- Department of Urology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ismet Yavascaoglu
- Department of Urology, Faculty of Medicine, Uludag University, Bursa, Turkey
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Delozier OM, Stiles ZE, Deschner BW, Drake JA, Deneve JL, Glazer ES, Tsao MW, Yakoub D, Dickson PV. Implications of Conversion during Attempted Minimally Invasive Adrenalectomy for Adrenocortical Carcinoma. Ann Surg Oncol 2020; 28:492-501. [PMID: 32656720 DOI: 10.1245/s10434-020-08824-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although advocated by some, minimally invasive adrenalectomy (MIA) for adrenocortical carcinoma (ACC) is controversial. Moreover, the oncologic implications for patients requiring conversion to an open procedure during attempted MIA for ACC are not extensively reported. PATIENTS AND METHODS The National Cancer Database was queried for patients undergoing resection for ACC. Overall survival (OS) for patients undergoing successful MIA was compared with those requiring conversion, and additionally evaluated with a multivariable Cox regression analysis including other factors associated with OS. After propensity matching, those experiencing conversion were further compared with patients who underwent planned open resection. RESULTS Among 196 patients undergoing attempted MIA for ACC, 38 (19.4%) required conversion. Independent of 90-day postoperative mortality, conversion was associated with significantly reduced OS compared with successful MIA (median 27.9 months versus not reached, p = 0.002). Even for tumors confined to the adrenal, conversion was associated with worse median OS compared with successful MIA (median 34.2 months versus not reached, p = 0.003). After propensity matching for clinicopathologic covariates to establish well-balanced cohorts (N = 38 per group), patients requiring conversion during MIA had significantly worse OS than those having planned open resection (27.9 months versus 50.5 months, p = 0.020). On multivariable analysis for predictors of OS, conversion during MIA (HR 2.32, p = 0.003) was independently associated with mortality. CONCLUSIONS ACC is a rare tumor for which adequate oncologic resection is the only chance for cure. Given the relatively high rate of conversion and its associated inferior survival, open resection should be considered standard of care for known or suspected ACC.
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Affiliation(s)
- Olivia M Delozier
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Zachary E Stiles
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Benjamin W Deschner
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Justin A Drake
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Miriam W Tsao
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Danny Yakoub
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Paxton V Dickson
- Department of Surgery, Division of Surgical Oncology, University of Tennessee Health Science Center, Memphis, TN, USA.
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39
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Ji C, Lu Q, Chen W, Zhang F, Ji H, Zhang S, Zhao X, Li X, Zhang G, Guo H. Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy. BMC Urol 2020; 20:66. [PMID: 32517679 PMCID: PMC7285739 DOI: 10.1186/s12894-020-00637-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 06/03/2020] [Indexed: 01/20/2023] Open
Abstract
Background To compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center. Methods Between April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed. Results This study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes. Conclusions Minimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.
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Affiliation(s)
- Changwei Ji
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Qun Lu
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Wei Chen
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Feifei Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Hao Ji
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Shiwei Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Xiaozhi Zhao
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Xiaogong Li
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Gutian Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China.
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De Crea C, Arcuri G, Pennestrì F, Paolantonio C, Bellantone R, Raffaelli M. Robotic adrenalectomy: evaluation of cost-effectiveness. Gland Surg 2020; 9:831-839. [PMID: 32775276 DOI: 10.21037/gs.2020.03.44] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Laparoscopic adrenalectomy (LA) is the preferred treatment option for adrenal lesions, considering the improved patients outcomes, due to the reduced postoperative morbidity and postoperative pain, the faster recovery and the shorter length of hospital stay. The widespread diffusion of robotic technology led to the development and standardization of robot-assisted approach to adrenalectomy. However, to date, no clear benefit from the use of the robot-assisted approach has been found. The higher costs remain an important drawback and limit the implementation of robot-assisted adrenalectomy (RA) programs. This review summarizes the current available data regarding RA including its operative outcomes, advantages and drawbacks in comparison with conventional LA, evaluating its cost-effectiveness.
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Affiliation(s)
- Carmela De Crea
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Arcuri
- UOC Tecnologie Sanitarie, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Pennestrì
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Chiara Paolantonio
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Rocco Bellantone
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marco Raffaelli
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.,UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Roma, Italy
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Sforza S, Minervini A, Tellini R, Ji C, Bergamini C, Giordano A, Lu Q, Chen W, Zhang F, Ji H, Di Maida F, Prosperi P, Masieri L, Carini M, Valeri A, Guo H. Perioperative outcomes of robotic and laparoscopic adrenalectomy: a large international multicenter experience. Surg Endosc 2020; 35:1801-1807. [PMID: 32328826 DOI: 10.1007/s00464-020-07578-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The aim of the study was to describe the surgical outcomes of a retrospective series of consecutive patients treated with laparoscopic and robotic approach for adrenal masses in two tertiary referral centers. METHODS We retrospectively gathered data of 477 patients submitted to adrenalectomy performed at two Institutions from March 2008 to February 2018 by six highly experienced surgeons. We excluded from the analysis 43 patients that had an open approach for tumors or for anesthetic contraindications to minimally invasive surgery (MIS). Patients were selected for surgery after a radiologic and an endocrinology work up. Preoperative, perioperative and postoperative data were recorded. RESULTS Overall, 477 patients were included in the study. The robotic and the laparoscopic group included 110 and 367 patients, respectively. The preoperative characteristics were similar in both groups except for ASA score with a median (IQR) of 3 and 2 in the robotic and in the laparoscopic group, respectively (p = 0.03). Tumor size of adrenal tumors treated robotically (4, IQR 2.6-6 cm) was significantly larger than those treated laparoscopically (3, IQR 2.3-4.1 cm) (p = 0.01). The intraoperative complication rates were similar between robotic and laparoscopic groups (6.3% and 6%, respectively). The postoperative complication rate was 5.4% for robotic group and similarly 3.5% for laparoscopic adrenalectomy strategy. We analyzed the tumor ≥ 6 cm, with 29 patients in the robotic group and 43 in the laparoscopic one, with an overall complication rate of 19.5%. At multivariable analyses tumor size (OR 1.287; CI 1.128-1.468; p < 0.001) was the only independent predictor of overall complication. CONCLUSION Adrenal tumors can be safely treated either by robotic or laparoscopic strategy. MIS seems to be feasible also in larger adrenal masses (≥ 6 cm). Tumor size represents the only predictive factors for overall complication.
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Affiliation(s)
- Simone Sforza
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy.
| | - Andrea Minervini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Riccardo Tellini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Changwei Ji
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | | | | | - Qun Lu
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Wei Chen
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Feifei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Hao Ji
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
| | - Fabrizio Di Maida
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Paolo Prosperi
- Emergency Surgery Unit, Careggi Hospital, Florence, Italy
| | - Lorenzo Masieri
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Marco Carini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, San Luca Nuovo, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Valeri
- Emergency Surgery Unit, Careggi Hospital, Florence, Italy
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
- Institute of Urology, Nanjing University, Nanjing, China
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Mazzaglia PJ, Varghese J, Habra MA. Evaluation and management of adrenal neoplasms: endocrinologist and endocrine surgeon perspectives. Abdom Radiol (NY) 2020; 45:1001-1010. [PMID: 32189021 DOI: 10.1007/s00261-020-02464-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The evaluation and management of adrenal disease is a complex endeavor that relies on an expert knowledge of human physiology and anatomy. Careful and proper patient assessment mandates a balanced approach which marries the disciplines of endocrinology, surgery, and radiology. Any of these three specialties may be on the front line in performing the initial workup when an adrenal neoplasm is discovered. With an ever-increasing volume of cross-sectional imaging, be it CT, MRI, or PET, large numbers of adrenal incidentalomas are being discovered. A close collaboration amongst specialties should strive to streamline the initial evaluation and minimize unnecessary testing and treatment.
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Laparoscopic Approach to the Adrenal Masses: Single-Center Experience of Five Years. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:52-57. [PMID: 32377134 PMCID: PMC7192254 DOI: 10.14744/semb.2019.40225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/30/2019] [Indexed: 12/27/2022]
Abstract
Objectives: Currently, laparoscopic adrenalectomy is the gold standard technique for suitable patients with adrenal masses. In this study, we aimed to assess the postoperative results of patients who underwent laparoscopic adrenalectomy. Methods: Between January 2014 and October 2019, 76 cases were operated and retrospectively evaluated. Laparoscopic transabdominal adrenalectomy was applied to the patients. Demographic profiles, preoperative indications, intraoperative and postoperative complications, mortality and length of hospital stay were evaluated. Results: Seventy-six patients (30 male, 46 female) with a mean age of 47.2±11.7 (range 22-71) years underwent laparoscopic adrenalectomy. Thirty-nine of the patients had right; 33 of the patients had left adrenal masses. Three patients had bilateral adrenal cortical hyperplasia. One patient was operated for paraganglioma. Conversion to open adrenalectomy was observed in four patients (5.26%). Nine patients (11.8%) experienced intraoperative and postoperative complications. Intraoperative and postoperative complications were bleeding from spleen (2 cases) and upper pole of kidney (1 case), renal artery injury (1 case), bleeding from liver parenchyma (2 cases), ischemia of spleen and pancreas (1 case), small intestinal injury (1 case) and incisional hernia (1 case). The complication rate is acceptable and comparable with other studies in the literature. Conclusion: Laparoscopic adrenalectomy can be safely applied in suitable patients with acceptable complications and low conversion rates.
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Sahbaz NA, Dural AC, Akarsu C, Guzey D, Kulus M, Dogansen SC, Mert M, Alis H. Transperitoneal laparoscopic surgery in large adrenal masses. Wideochir Inne Tech Maloinwazyjne 2020; 15:106-111. [PMID: 32117492 PMCID: PMC7020710 DOI: 10.5114/wiitm.2019.85177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/19/2019] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The laparoscopic adrenalectomy (LA) has become the gold standard since the transperitoneal laparoscopic approach was first reported. AIM To evaluate the applicability, safety and short-term results of laparoscopic surgery in adrenal masses over 6 cm. MATERIAL AND METHODS Demographic data, hormonal activities, imaging modalities, operative findings, operation time, conversion rates, complications, duration of hospital stay and histopathologic results of 128 patients who underwent laparoscopic adrenalectomy were evaluated retrospectively. Patients included in the learning curve (n = 23), robotic surgery cases (n = 15) and patients with suspected metastasis (n = 4) were excluded from the study. Six cm mass size was taken as a reference and two groups were formed (group 1: < 6 cm, group 2: ≥ 6 cm). The results of the two groups were compared. RESULTS There were 64 cases in group 1 and 22 cases in group 2. Functional mass ratio and mass sides were similar between the groups (p = 0.30 and p = 0.17, respectively). The mean mass size in group 1 was 36.4 ±11.2 mm and in group 2 82.4 ±15.5 mm. The conversion rate was similar between the two groups (p = 0.18). The duration of surgery was 135.5 ±8.29 min in group 1, 177.0 ±14.9 min in group 2 (p = 0.014). Morbidity and lengths of hospital stay were similar (p = 0.76, p = 0.34 respectively). Adrenocortical carcinoma was detected in three cases in group 1, which were completed laparoscopically, and in two cases in group 2, which were converted to open surgery (p = 0.46). CONCLUSIONS Although open surgery is still recommended in the guidelines, studies are now being carried out to ensure that laparoscopy can be safely performed on masses over 6 cm. There was no difference between short-term follow-up and histopathologic results in our study.
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Affiliation(s)
- Nuri Alper Sahbaz
- Department of Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Cem Dural
- Department of Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cevher Akarsu
- Department of Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Deniz Guzey
- Department of Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kulus
- Department of Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sema Ciftci Dogansen
- Department of Endocrinology, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Meral Mert
- Department of Endocrinology, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Halil Alis
- Department of Surgery, Faculty of Medicine, Aydin University, VM Medical Park Florya Hospital, Istanbul, Turkey
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Nomine-Criqui C, Demarquet L, Schweitzer ML, Klein M, Brunaud L, Bihain F. Robotic adrenalectomy: when and how? Gland Surg 2020; 9:S166-S172. [PMID: 32175258 DOI: 10.21037/gs.2019.12.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Currently, laparoscopic adrenalectomy is considered as the preferred technique to manage adrenal tumors. However, there are no prospective randomized studies evaluating this strategy. With the recent advances in surgical equipment and the widespread of robotic technology, a robotic approach is considered as an interesting option in some medical centers. This approach seems to be feasible and safe but high-level evidence of its benefits is still lacking. This review summarizes indications, advantages and drawbacks of robotic adrenalectomy and describes its surgical technique.
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Affiliation(s)
- Claire Nomine-Criqui
- Unit of Metabolic, Endocrine, and Thyroid Surgery (UMET), Department of Visceral and Metabolic Surgery, Hospital Brabois Adultes, CHRU Nancy, University of Lorraine, Nancy, France
| | - Lea Demarquet
- Department of Endocrinology, Diabetology and Nutrition, CHU Nancy, University of Lorraine, Nancy, France
| | - Marie Laure Schweitzer
- Department of Endocrinology, Diabetology and Nutrition, CHU Nancy, University of Lorraine, Nancy, France
| | - Marc Klein
- Department of Endocrinology, Diabetology and Nutrition, CHU Nancy, University of Lorraine, Nancy, France
| | - Laurent Brunaud
- Unit of Metabolic, Endocrine, and Thyroid Surgery (UMET), Department of Visceral and Metabolic Surgery, Hospital Brabois Adultes, CHRU Nancy, University of Lorraine, Nancy, France.,INSERM U1256, Nutrition, Genetics, Environmental Risks, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Florence Bihain
- Unit of Metabolic, Endocrine, and Thyroid Surgery (UMET), Department of Visceral and Metabolic Surgery, Hospital Brabois Adultes, CHRU Nancy, University of Lorraine, Nancy, France
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Abstract
According to the Endocrine Society Clinical Practice Guidelines, the goal of treating overt Cushing's syndrome is to control cortisol levels or more importantly its actions at its receptor in order to eliminate the end organ effects and treat comorbidities associated with hypercortisolism. This chapter will review the surgical management of hypercortisolism. It will be subdivided into two main sections: the management of: (I) ACTH-dependent; and (II) ACTH-independent (adrenal) hypercortisolism. The perioperative factors that surgeons should consider after the diagnosis has been made will also be discussed. Lastly, the utilization of robotic surgery for adrenalectomy and the perceived benefits and potential pitfalls of this approach when treating patients with hypercortisolism will be reviewed.
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Vidal O, Saavedra-Perez D, Martos JM, de la Quintana A, Rodriguez JI, Villar J, Ortega J, Moral A, Duran M, Valentini M, Fernandez-Cruz L. Risk factors for open conversion of lateral transperitoneal laparoscopic adrenalectomy: retrospective cohort study of the Spanish Adrenal Surgery Group (SASG). Surg Endosc 2019; 34:3690-3695. [DOI: 10.1007/s00464-019-07264-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
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48
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Balla A, Palmieri L, Meoli F, Corallino D, Ortenzi M, Ursi P, Guerrieri M, Quaresima S, Paganini AM. Are Adrenal Lesions of 6 cm or More in Diameter a Contraindication to Laparoscopic Adrenalectomy? A Case–Control Study. World J Surg 2019; 44:810-818. [DOI: 10.1007/s00268-019-05287-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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49
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Mihai R, Donatini G, Vidal O, Brunaud L. Volume-outcome correlation in adrenal surgery-an ESES consensus statement. Langenbecks Arch Surg 2019; 404:795-806. [PMID: 31701230 PMCID: PMC6908553 DOI: 10.1007/s00423-019-01827-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Published data in the last decade showed that a majority of adrenal operations are done by surgeons performing only one such case per year and based on the distribution of personal workloads 'high-volume' surgeons are defined as those doing 4 or more cases/year. PURPOSE This paper summarises literature data identified by a working group established by the European Society of Endocrine Surgeons (ESES). The findings were discussed during ESES-2019 conference and members agreed on a consensus statement. RESULTS The annual of adrenal operations performed yearly in individual countries was reported to be 800/year in UK and over 1600/year in France. The learning curve of an individual surgeon undertaking laparoscopic, retroperitoneoscopic or robotic adrenalectomy is estimated to be 20-40 cases. Preoperative morbidity and length of stay are more favourable in high-volume centres. CONCLUSION The main recommendations are that adrenal surgery should continue only in centres performing at least 6 cases per year, surgery for adrenocortical cancer should be restricted to centres performing at least 12 adrenal operations per year, and an integrated multidisciplinary team should be established in all such centres. Clinical information regarding adrenalectomies should be recorded prospectively and contribution to the established EUROCRINE and ENSAT databases is strongly encouraged. Surgeons wishing to develop expertise in this field should seek mentorship and further training from established adrenal surgeons.
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Affiliation(s)
- Radu Mihai
- Churchill Cancer Centre, Oxford University NHS Hospitals Foundation Trust, Oxford, UK
| | - Gianluca Donatini
- Department of Surgery and INSERM U1082, CHU Poitiers, University of Poitiers, Poitiers, France
| | - Oscar Vidal
- ICMDiM, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Laurent Brunaud
- Department of Surgery and INSERM U954, CHU Nancy (Brabois), Université de Lorraine, Vandoeuvre les Nancy, France
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Dworak J, Wysocki M, Rzepa A, Natkaniec M, Pędziwiatr M, Budzyński A, Major P. Laparoscopic adrenalectomy - is it safe in hands of residents in training? BMC Urol 2019; 19:102. [PMID: 31660932 PMCID: PMC6816204 DOI: 10.1186/s12894-019-0538-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 10/10/2019] [Indexed: 01/10/2023] Open
Abstract
Background Laparoscopic adrenalectomy (LA) has become the “gold standard” for treating most adrenal tumors in the past decade. However, it is still considered a relatively complicated procedure requiring experience from surgeon. The aim of the study was to evaluate the safety of laparoscopic adrenalectomy performed by residents who are undergoing training in general surgery. Methods A prospectively collected database containing all 300 transperitoneal laparoscopic adrenalectomies performed in II Department of General Surgery JU MC, Krakow between January 2013 and March 2018 was retrospectively reviewed. Patients were divided into two groups; patients operated on by residents (group 1, 54 operations) and by attending general surgeons (group 2, 246 operations). We compared the course of the operation and patient hospitalization in these two groups. If the operation was completed by a different person than the one who started the procedure, we refer to this as “operator conversion”. Results We found no differences in demographic factors or comorbidities between the two groups. The mean operative time was similar in the residents’ and the specialists’ groups (p = 0.5761). Median blood loss did not differ between the groups (p = 0.4325). The overall ratio of intraoperative adverse events was similar in both groups (p = 0.8643). The difference in the ratio of perioperative complications between the groups was not statistically significant (p = 0.6442). The average mean hospital stay after surgery was 2 days for both groups. We identified 25 cases (8.33%) of operator conversion; the difference in operator conversions between two groups was not statistically significant (p = 0.1741). Conclusions Laparoscopic transperitoneal adrenalectomy performed by a supervised resident is a safe procedure. The course of the operation and patient hospitalization did not differ importantly when comparing procedures performed by residents and attending surgeons. Liberal use of operator conversions from resident to attending surgeon and from a surgeon to a senior surgeon provides reasonable safety and prevents complications. In high-volume centers performing minimally invasive techniques, closed supervision allows residents to safely perform LA.
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Affiliation(s)
- Jadwiga Dworak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Anna Rzepa
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Natkaniec
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.
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