Predictive factors and radiological findings of adrenohepatic adhesion during laparoscopic adrenalectomy

Abstract

This retrospective study aimed to identify predictive factors and imaging features of adrenohepatic adhesion found during laparoscopic right adrenalectomy. Materials and Methods: Altogether, 77 patients underwent laparoscopic right adrenalectomy between January 2005 and December 2018. Adrenohepatic adhesion was defined as strict adhesion that required either partial adrenalectomy with coagulation of residual tissue or partial hepatectomy to accomplish complete resection. We assessed their surgical video records to determine if adrenohepatic adhesion was present. Age, sex, body mass index, tumor size, tumor diagnosis and radiological findings (attachment between the liver and the adrenal gland, diameters of the right and left adrenal veins and its ratio) were evaluated as preoperative variables. Results: Adrenohepatic adhesion was present in 11 of the 77 patients (14.3%). Age, sex, and body mass index were not statistically significant factors. Tumor size was significantly small in adhesion group (14.2 mm vs. 25.9 mm, p=0.02). Attachment to the liver and adrenal gland was frequently seen regardless of the adhesion. The mean right/left adrenal veins diameters ratio was significantly lower in the adhesion group (0.8 vs. 1.1, p=0.01). Multivariate logistic regression analysis demonstrated the right/left adrenal veins diameters ratio was the only significant predictor of adhesion. The sensitivity, specificity, negative predictive value and positive predictive value were 0.82, 0.76, 0.43, and 0.95 respectively when the optimal cutoff value for the ratio was 0.9 (area under the curve, 0.75; 95% confidence interval, 0.60-0.90). Conclusions: The right/left adrenal veins diameters ratio was possible predictor of adrenohepatic adhesion.

Preoperative Detection of Liver Involvement by Right-Sided Adrenocortical Carcinoma Using CT and MRI

“…Since the aim of our work was to identify new imaging signs associated with DLI by right-sided ACC, we tried to transpose these signs and their definitions for the study of locoregional extension of ACC. The fat border between ACC and liver was considered to be non-measurable and absent when <1 mm [ 10 ]. Periadrenal fat densification was defined on CT by a difference in attenuation values >10 Hounsfield units (HU) between normal retroperitoneal fat and peritumoral fat [ 15 ].…”

“…Imaging also has a main role in tumor staging and preoperative planning of surgical approach [ 7 ]. To our knowledge, very few studies have been performed to identify preoperative imaging signs of direct liver involvement (DLI) in right-sided ACC [ 10 , 11 ].…”