Postoperative outcomes of minimally invasive adrenalectomy: do body mass index and tumor size matter? A single-center experience

Abstract

Background Since Gagner performed the first laparoscopic adrenalectomy in 1992, laparoscopy has become the gold-standard procedure in the treatment of adrenal surgical diseases. A review of the literature indicates that the rate of intra- and postoperative complications are not negligible. This study aims to describe the single-center experience of adrenalectomies; and explore the associations between body mass index (BMI) and tumor volume in main postoperative outcomes. Methods Retrospective observational study with a prospective database in which we described patients who underwent adrenalectomy between January 2015 and December 2020. Operative time, intraoperative blood loss, conversion rate, complications, length of hospital stay, and comparison of the number of antihypertensive drugs used before and after surgery were analyzed. Analysis of BMI and tumor volume with postoperative outcomes such as anti-hypertensive change (AHC) in drug usage and pre-operative conditions were performed. Results Forty-five adrenalectomies were performed, and all of them were carried out laparoscopically. Four were performed as a robot-assisted laparoscopy approach. Nineteen were women and 26 were men. Mean age was 54.9 ± 13.8 years. Mean tumor volume was 95.698 mm3 (3.75–1010.87). Mean operative time was shorter in right tumors (2.64 ± 0.75 h) than in left tumors (3.33 ± 2.73 h). Pearson correlation was performed to assess the relationship between BMI and AHC showing a direct relationship between increased BMI and higher change in anti-hypertensive drug usage at postoperative period r(45) = 0.92, p > 0.05 CI 95%. Higher tumor volume showed a longer operative time, r(45) = 0.6 (p = 0.000 CI 95%). Conclusions Obese patients could have an increased impact with surgery with an increased change in postoperative anti-hypertensive management. Tumor volume is associated with increased operative time and blood loss, our data suggest that it could be associated with increased rates of morbidity. However, further prospective studies with larger sample sizes are needed to validate our results.

Retroperitoneoscopic adrenalectomy may be superior to laparoscopic transperitoneal adrenalectomy in terms of costs and profit: a retrospective pair-matched cohort analysis

“…Studies have shown that the laterality and size of adrenal tumors (for tumors < 6 cm) did not affect the duration of surgery or postoperative morbidity, either for LTA or RPA. Therefore, these two variables were not included as independent variables in our matching [ 37 – 39 ].…”

Feasibility of laparoscopic adrenalectomy in adrenal masses greater than 5 centimeters: a systematic review and meta-analysis

“…While LA is the gold standard for managing small adrenal masses, its application for larger lesions (>5 cm) remains controversial due to concerns about technical feasibility, oncological safety, and limited high-quality evidence ( 5 ) Therefore, a systematic review and meta-analysis was carried out to comprehensively assess the existing literature, address knowledge gaps, and inform clinical practice, which ultimately impact patient care by establishing the efficacy and safety of LA for large masses. This study was conducted to evaluate the feasibility of LA in adrenal masses greater than 5 cm in terms of safety, effectiveness, and complications.…”