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Lelli G, Micalizzi A, Iossa A, Fassari A, Concistre A, Circosta F, Petramala L, De Angelis F, Letizia C, Cavallaro G. Application of enhanced recovery after surgery (ERAS) protocols in adrenal surgery: A retrospective, preliminary analysis. J Minim Access Surg 2024; 20:163-168. [PMID: 37282440 PMCID: PMC11095811 DOI: 10.4103/jmas.jmas_319_22] [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: 11/14/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The present study was conducted to evaluate the impact of enhanced recovery after surgery (ERAS) pathway in patients undergoing laparoscopic adrenalectomy (LA) for primary and secondary adrenal disease, in reducing the length of primary hospital stay and return to daily activities. MATERIALS AND METHODS This retrospective study was carried out on 61 patients who underwent LA. A total of 32 patients formed the ERAS group. A total of 29 patients received conventional perioperative care and were assigned as the control group. Groups were compared in terms of patient's characteristics (sex, age, pre-operative diagnosis, side of tumour, tumour size and co-morbidities), post-operative compliance (anaesthesia time, operative time, post-operative stay, post-operative numeric rating scale (NRS) score, analgesic assumption and days to return to daily activities) and post-operative complications. RESULTS No significant differences in anaesthesia time ( P = 0.4) and operative time ( P = 0.6) were reported. NRS score 24 h postoperatively was significantly lower in the ERAS group ( P < 0.05). The analgesic assumption in post-operative period in the ERAS group was lower ( P < 0.05). ERAS protocol led to a significantly shorter length of post-operative stay ( P < 0.05) and to return to daily activities ( P < 0.05). No differences in peri-operative complications were reported. DISCUSSION ERAS protocols seem safe and feasible, potentially improving perioperative outcomes of patients undergoing LA, mainly improving pain control, hospital stay and return to daily activities. Further studies are needed to investigate overall compliance with ERAS protocols and their impact on clinical outcomes.
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Affiliation(s)
- Giulio Lelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Alessandra Micalizzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Alessia Fassari
- General Surgery Unit, Centre Hospitalier de Luxembourg, Luxembourg, Europe
| | - Antonio Concistre
- Department of Cinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Francesco Circosta
- Department of Cinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Luigi Petramala
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesco De Angelis
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Claudio Letizia
- Department of Cinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Giuseppe Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
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Xu C, Xu P, Zhang J, He S, Hua T, Huang A. Research progress and perspectives of noncoding RNAs in adrenocortical carcinoma: A review. Medicine (Baltimore) 2024; 103:e36908. [PMID: 38277554 PMCID: PMC10817030 DOI: 10.1097/md.0000000000036908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/18/2023] [Indexed: 01/28/2024] Open
Abstract
Adrenocortical carcinoma (ACC) is a rare and highly aggressive endocrine malignancy. Although surgery can cure localized disease, but the majority of patients experience recurrence of ACC. The 5-year survival rate of patients with metastatic ACC is <15%, and the prognosis is poor. Therefore, it is urgent to explore the potential diagnostic markers and therapeutic targets for ACC. Recently, it has been proved that non-coding RNA (ncRNAs) is widely involved in pathological and physiological processes, including tumorigenesis and development. Aberrantly expressed ncRNAs have been found to be involved in the pathogenesis of ACC. Here, we summarized the expression patterns and the molecular mechanism of the involvement of microRNAs (miRNAs), long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs) in ACC development. To explore the clinical value of ncRNAs as noninvasive biomarkers of ACC, we also displayed the relationship between the expression level of ncRNAs and the diagnosis and prognosis of patients with ACC.
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Affiliation(s)
- Changfen Xu
- Department of Gynecology and Obstetrics, Hangzhou Lin’an TCM Hospital, Lin’an District, Hangzhou, China
| | - Peiyao Xu
- Department of Gynecology and Obstetrics, Hangzhou Lin’an TCM Hospital, Lin’an District, Hangzhou, China
| | - Jiaqi Zhang
- Department of Gynecology and Obstetrics, Hangzhou Lin’an TCM Hospital, Lin’an District, Hangzhou, China
| | - Sheng He
- Department of Gynecology and Obstetrics, Hangzhou Lin’an TCM Hospital, Lin’an District, Hangzhou, China
| | - Tingting Hua
- Department of Gynecology and Obstetrics, Hangzhou Lin’an TCM Hospital, Lin’an District, Hangzhou, China
| | - Aiwu Huang
- Department of Gynecology and Obstetrics, Hangzhou Lin’an TCM Hospital, Lin’an District, Hangzhou, China
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Logan CD, Nunnally SEA, Valukas C, Warwar S, Swinarska JT, Lee FT, Bentrem DJ, Odell DD, Elaraj DM, Sturgeon C. Association between travel distance and overall survival among patients with adrenocortical carcinoma. J Surg Oncol 2023; 128:749-763. [PMID: 37403612 PMCID: PMC10997292 DOI: 10.1002/jso.27387] [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: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Regionalization of care is associated with improved perioperative outcomes after adrenalectomy. However, the relationship between travel distance and treatment of adrenocortical carcinoma (ACC) is unknown. We investigated the association between travel distance, treatment, and overall survival (OS) among patients with ACC. METHODS Patients diagnosed with ACC between 2004 and 2017 were identified with the National Cancer Database. Long distance was defined as the highest quintile of travel (≥42.2 miles). The likelihood of surgical management and adjuvant chemotherapy (AC) were determined. The association between travel distance, treatment, and OS was evaluated. RESULTS Of 3492 patients with ACC included, 2337 (66.9%) received surgery. Rural residents were more likely to travel long distances for surgery than metropolitan residents (65.8% vs. 15.5%, p < 0.001), and surgery was associated with improved OS (HR 0.43, 95% CI 0.34-0.54). Overall, 807 (23.1%) patients received AC with rates decreasing approximately 1% per 4-mile travel distance increase. Also, long distance travel was associated with worse OS among surgically treated patients (HR 1.21, 95% CI 1.05-1.40). CONCLUSIONS Surgery was associated with improved overall survival for patients with ACC. However, increased travel distance was associated with lower likelihood to receive adjuvant chemotherapy and decreased overall survival.
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Affiliation(s)
- Charles D. Logan
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Department of Surgery, Canning Thoracic Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Sara E. A. Nunnally
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Catherine Valukas
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Samantha Warwar
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Joanna T. Swinarska
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Frances T. Lee
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David J. Bentrem
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - David D. Odell
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
- Department of Surgery, Canning Thoracic Institute, Northwestern Medicine, Chicago, Illinois, USA
| | - Dina M. Elaraj
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
| | - Cord Sturgeon
- Department of Surgery, Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern Medicine, Chicago, Illinois, USA
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Giordano A, Feroci F, Podda M, Botteri E, Ortenzi M, Montori G, Guerrieri M, Vettoretto N, Agresta F, Bergamini C. Minimally invasive versus open adrenalectomy for adrenocortical carcinoma: the keys surgical factors influencing the outcomes-a collective overview. Langenbecks Arch Surg 2023; 408:256. [PMID: 37386332 DOI: 10.1007/s00423-023-02997-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Adrenocortical carcinoma (A.C.C.) is a rare tumour, often discovered at an advanced stage and associated with a poor prognosis. Surgery is the treatment of choice. We aimed to review the different surgical approaches trying to compare their outcome. METHODS This comprehensive review has been carried out according to the PRISMA statement. The literature search was performed in PubMed, Scopus, the Cochrane Library and Google Scholar. RESULTS Among all studies identified, 18 were selected for the review. A total of 14,600 patients were included in the studies, of whom 4421 were treated by mini-invasive surgery (M.I.S.). Ten studies reported 531 conversions from M.I.S. to an open approach (OA) (12%). Differences were reported for operative times as well as for postoperative complications more often in favour of OA, whereas differences for hospitalization time in favour of M.I.S. Some studies showed an R0 resection rate from 77 to 89% for A.C.C. treated by OA and 67 to 85% for tumours treated by M.I.S. The overall recurrence rate ranged from 24 to 29% for A.C.C. treated by OA and from 26 to 36% for tumours treated by M.I.S. CONCLUSIONS OA should still be considered the standard surgical management of A.C.C. Laparoscopic adrenalectomy has shown shorter hospital stays and faster recovery compared to open surgery. However, the laparoscopic approach resulted in the worst recurrence rate, time to recurrence and cancer-specific mortality in stages I-III ACC. The robotic approach had similar complications rate and hospital stays, but there are still scarce results about oncologic follow-up.
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Affiliation(s)
- Alessio Giordano
- Department of Surgery, General Surgery unit, S. Stefano Hospital, Azienda ASL Toscana Centro, Suor Niccolina Infermiera 20/22, 59100, Prato, Italy.
| | - Francesco Feroci
- Department of Surgery, General Surgery unit, S. Stefano Hospital, Azienda ASL Toscana Centro, Suor Niccolina Infermiera 20/22, 59100, Prato, Italy
| | - Mauro Podda
- Department of Surgery, General Surgery Unit, University Hospital of Cagliari, Cagliari, Italy
| | - Emanuele Botteri
- General Surgery Unit, ASST Spedali Civili Di Brescia, Montichiari, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy
| | - Giulia Montori
- Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Ancona, Italy
| | - Nereo Vettoretto
- General Surgery Unit, ASST Spedali Civili Di Brescia, Montichiari, Italy
| | - Ferdinando Agresta
- Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Italy
| | - Carlo Bergamini
- Department of Emergency, Emergency General Surgery Unit, AOU Careggi, Firenze, Italy
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Hou Q, Zhang B, Luo Y, Wang P, Yang S, Shang P. Predictive Factors for Conversion from Laparoscopic Adrenalectomy to Open Surgery: A 9-Year Review of 911 Cases. J Laparoendosc Adv Surg Tech A 2023; 33:38-43. [PMID: 35617700 DOI: 10.1089/lap.2022.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: With the development of minimally invasive techniques, laparoscopic adrenalectomy (LA) has become the standard for the treatment of adrenal surgical diseases, but conversion to open adrenalectomy (OA) is also necessary in some cases. The purpose of this study was to investigate the risk factors for conversion from LA to OA. Methods: A retrospective study was performed on 911 patients who were diagnosed with adrenal tumors and underwent LA in the Department of Urology, Second Hospital of Lanzhou University from January 2013 to December 2021. According to the surgical methods, the patients were divided into the laparoscopic group (n = 873) and the conversion group (n = 38). Logistic regression was used to analyze the independent risk factors of conversion, and the logistic regression equation was established to predict the probability of conversion. Results: In this study, 38 patients (4.17%) were converted to open. In the univariate analysis, body mass index (P = .037), tumor side (P < .001), tumor size (P < .001), surgical approach (P < .001), and histological type (P = .006) were significantly associated with conversion. In the multivariate analysis, tumor diameter >7 cm (odds ratio = 2.835, 95% confidence interval 1.096-7.335; P = .032), transabdominal approach (odds ratio = 2.400, 95% confidence interval 1.136-5.074; P = .022), pheochromocytoma (odds ratio = 5.018, 95% confidence interval 1.964-12.822; P = .001), and malignant tumor (odds ratio = 17.781, 95% confidence interval 4.156-76.075; P < .001) were independent risk factors for transition opening. The logistic regression equation showed good power to predict conversion. Conclusion: Tumor size, surgical approach, and histological type were predictive factors for conversion from a laparoscopic to an open procedure. Preoperative evaluation of these characteristics is of great value for clinicians to evaluate the risk of conversion and make a surgical plan. It can not only reduce the conversion rate but also help to improve the intraoperative situation and shorten the length of hospital stays.
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Affiliation(s)
- Qian Hou
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Biao Zhang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Yao Luo
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Pengyuan Wang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Shujun Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Panfeng Shang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
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Bernardi S, Calabrò V, Cavallaro M, Lovriha S, Eramo R, Fabris B, de Manzini N, Dobrinja C. Is the Adrenal Incidentaloma Functionally Active? An Approach-To-The-Patient-Based Review. J Clin Med 2022; 11:jcm11144064. [PMID: 35887828 PMCID: PMC9323753 DOI: 10.3390/jcm11144064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/01/2022] [Accepted: 07/10/2022] [Indexed: 02/01/2023] Open
Abstract
Adrenal incidentalomas are a common occurrence. Most of them are adrenocortical adenomas that do not cause harm and do not require surgery, but a non-negligible proportion of incidentalomas is represented by functionally active masses, including cortisol-secreting adenomas (12%), pheochromocytomas (3–6%), aldosterone-secreting adenomas (2–3%), as well as malignant nodules, such as adrenocortical carcinomas (2–5%), which can be either functioning or non-functioning. All patients with an adrenal incidentaloma should undergo a few biochemical screening and confirmatory tests to exclude the presence of a functionally active mass. In this approach-to-the-patient-based review, we will summarize current recommendations on biochemical evaluation and management of functionally active adrenal incidentalomas. For this purpose, we will present four case vignettes, whereby we will describe how patients were managed, then we will review and discuss additional considerations tied to the diagnostic approach, and conclude with practical aspects of patient perioperative management. To improve the perioperative management of patients with functional adrenal incidentalomas, multidisciplinary meetings are advocated.
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Affiliation(s)
- Stella Bernardi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (S.L.); (B.F.); (N.d.M.); or (C.D.)
- SS Endocrinologia, UCO Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy;
- Correspondence: ; Tel.: +39-(0)403994318
| | - Veronica Calabrò
- SS Endocrinologia, UCO Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Marco Cavallaro
- UCO Radiologia, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Sara Lovriha
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (S.L.); (B.F.); (N.d.M.); or (C.D.)
- SS Endocrinologia, UCO Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Rita Eramo
- UCO Clinica Chirurgica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Bruno Fabris
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (S.L.); (B.F.); (N.d.M.); or (C.D.)
- SS Endocrinologia, UCO Medicina Clinica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (S.L.); (B.F.); (N.d.M.); or (C.D.)
- UCO Clinica Chirurgica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Chiara Dobrinja
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (S.L.); (B.F.); (N.d.M.); or (C.D.)
- UCO Clinica Chirurgica, ASUGI (Azienda Sanitaria Universitaria Giuliano Isontina), Cattinara Teaching Hospital, Strada di Fiume 447, 34149 Trieste, Italy;
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Al-Thani H, Al-Thani N, Al-Sulaiti M, Tabeb A, Asim M, El-Menyar A. A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches. Front Surg 2022; 9:848565. [PMID: 35310427 PMCID: PMC8927071 DOI: 10.3389/fsurg.2022.848565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 02/03/2023] Open
Abstract
BackgroundCurrently, adrenalectomies are trending toward minimally invasive approach including robotic and laparoscopic surgery. We aimed to describe the clinical presentation and outcomes associated with the 3 different surgical approaches in patients who underwent adrenalectomy for adrenal mass at a single tertiary center.MethodsA retrospective descriptive observational study was conducted to include all patients who underwent surgical interventions for adrenal gland mass between 2004 and 2019. Patients were categorized into three groups according to the interventional approach (open, robotic vs. laparoscopic adrenalectomy) and data were analyzed and compared.ResultsA total of 124 patients underwent adrenalectomies (61.3% robotic, 22.6% open, and 16.1% laparoscopic approach). Incidentally discovered adrenal mass was reported in 67% of patients, and hypertension was the most prevalent comorbidity (53%). The tendency for malignancy increased with increasing tumor size while the functioning tumors were more in the smaller tumor size. Larger tumors were more common in younger patients. The robotic approach showed shorter surgical intensive care and hospital length of stay. Patients in the open adrenalectomy group frequently presented with abdominal pain (p = 0.001), had more nonfunctional adrenal mass (p = 0.04), larger mean tumor size (p = 0.001), and were frequently operated on the right side (p = 0.03). There was no post-operative mortality; however, during follow-up, 8 patients died (3 open, 3 laparoscopic and, 2 robotic approach). The median follow-up was 746 days (range 7–5,840).ConclusionsThe study explored the three surgical adrenalectomy approaches in a dedicated center for patients with adrenal pathology. It showed that robotic adrenalectomy could be safe and effective surgical approach for patients with benign functioning adrenal tumors of a diameter <6 cm. However, the choice of a surgical approach varies according to the adrenal mass presentation, patient fitness for surgery, type and sizes of the tumor, surgeon's experience, and hospital resources. Open surgery is considered the first choice for larger, ruptured adrenal tumor or malignancy. However, the recent restructuring of the surgical department resulted in selection bias in favor of the robotic surgery. Further studies are required to address the risk factors, selection criteria for appropriate management, cost, and quality of life.
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Affiliation(s)
| | - Noora Al-Thani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | | | | | - Mohammad Asim
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
- *Correspondence: Ayman El-Menyar
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