Risk factors for complications after adrenalectomy: results from a comprehensive national database

Thompson, Lo Hallin; Nordenström, Erik; Almquist, Martin; Jacobsson, Helene; Bergenfelz, Anders

doi:10.1007/s00423-016-1535-8

Cited by 55 publications

(41 citation statements)

References 41 publications

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“…Predictive factors for in‐hospital mortality were malignant disease and adrenal tumour larger than 60 mm. The overall conversion rate from laparoscopic to open surgery was 5·1 per cent, and is comparable to other published conversation rates.…”

Section: Discussionsupporting

confidence: 81%

Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons' national registry

Patel

Egan

Carter

et al. 2019

British Journal of Surgery

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Background: This study investigated the indications, procedures and outcomes for adrenal surgery from the UK Registry of Endocrine and Thyroid Surgery database from 2005 to 2017, and compared outcomes between benign and malignant disease.Methods: Data on adrenalectomies were extracted from a national surgeon-reported registry. Preoperative diagnosis, surgical technique, length of hospital stay, morbidity and in-hospital mortality were examined.Results: Some 3994 adrenalectomies were registered among patients with a median age of 54 (i.q.r. 43-65) years (55⋅9 per cent female). Surgery was performed for benign disease in 81⋅5 per cent. Tumour size was significantly greater in malignant disease: 60 (i.q.r. 34-100) versus 40 (24-55) mm (P < 0⋅001). A minimally invasive approach was employed in 90⋅2 per cent of operations for benign disease and 48⋅2 per cent for cancer (P < 0⋅001). The conversion rate was 3⋅5-fold higher in malignant disease (17⋅3 versus 4⋅7 per cent; P < 0⋅001). The length of hospital stay was 3 (i.q.r. 2-5) days for benign disease and 5 (3-8) days for malignant disease (P < 0⋅050). In multivariable analysis, risk factors for morbidity were malignant disease (odds ratio (OR) 1⋅69, 1⋅22 to 2⋅36; P = 0⋅002), tumour size larger than 60 mm (OR 1⋅43, 1⋅04 to 1⋅98; P = 0⋅028) and conversion to open surgery (OR 3⋅48, 2⋅16 to 5⋅61; P < 0⋅001). The in-hospital mortality rate was below 0⋅5 per cent overall, but significantly higher in the setting of malignant disease (1⋅2 versus 0⋅2 per cent; P < 0⋅001). Malignant disease (OR 4⋅88, 1⋅17 to 20⋅34; P = 0⋅029) and tumour size (OR 7⋅47, 1⋅52 to 39⋅61; P = 0⋅014) were independently associated with mortality in multivariable analysis.Conclusion: Adrenalectomy is a safe procedure but the higher incidence of open surgery for malignant disease appears to influence postoperative outcomes.

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Section: Discussionsupporting

confidence: 81%

Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons' national registry

Patel

Egan

Carter

et al. 2019

British Journal of Surgery

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“…Adrenalectomy was already performed for recurrence of HCC in different settings after liver transplantation and extensive multivisceral resections or for palliative metastasectomy [ 18 – 20 ]. Minimal-invasive procedures were established for small tumor size and certain risk factors and belong to the standard today [ 21 – 25 ]. Most of our patients received a primarily open surgical procedure, because of malignancy, a larger size, and prior surgery with the risk for abdominal adhesion.…”

Section: Discussionmentioning

confidence: 99%

Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center

Teegen

Mogl

Pratschke

et al. 2018

International Journal of Surgical Oncology

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Introduction Adrenal metastasis of hepatocellular carcinoma (HCC) is a rare entity and can be treated by resection, local ablative therapy, or systemic therapy. Unfortunately, data about treatment outcome, especially in liver transplant recipients, are rare. Patients and Methods From 2005 to 2015, 990 liver resections and 303 liver transplantations because of HCC were performed at our clinic. We retrospectively analyzed treatment outcome of the patients with metachronous adrenal metastasis of HCC, who received either resection, local ablation, or surveillance only. Results 10 patients were identified (0.8%). 7 patients received liver transplantation for primary HCC therapy, 3 liver resection, and 1 a local ablative therapy. 8 patients underwent adrenalectomy (one via retroperitoneoscopy), one was treated with local ablation, and one had surveillance only. Seven out of eight patients had no surgical complications and one experienced a pancreatic fistula, treated conservatively. 37.5% of the resected patients had recurrence 1 year after adrenalectomy and 75% after 2 years. The mean survival time after primary diagnosis of HCC was 96.6±22.4 months. After adrenalectomy, the mean survival time was 112.4±25.2 months. The mean time until tumor recurrence was 13.2±3.8 in the total cohort and 15.8±3.8 months in patients after adrenalectomy. The estimated overall survival after adrenalectomy was 77.2±17.4 months. Conclusion Metachronous adrenal metastasis occured in less than 1% of HCC patients. Adrenalectomy is a safe procedure and leads to acceptable survival rates even after liver transplantion. Therefore, it should be performed whenever the primary tumor is well controlled and the patient is in adequate physical condition.

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“…Moreover, conversion is an independent risk factor of complications in patients who undergo LTA [ 13 , 14 ]. In our study, the conversion rate was 2% (3/150); similarly, the rates of conversion from laparoscopic to open adrenalectomy, among patients with previous abdominal surgery, range from 1% to 11% in published work [ 5 , 7 , 9 , 14 ]. Similarly to earlier reports, bleeding was the most common surgical complication of LTA in our study [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Lateral laparoscopic adrenalectomy in patients with previous abdominal surgery - single-center experience.

Toutounchi

Pogorzelski

Legocka

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionLateral transabdominal adrenalectomy (LTA) is the most common minimally invasive technique used to treat patients with adrenal tumors.AimTo analyze intra-operative and post-operative complications and reasons for conversion to open surgery in patients who underwent LTA and had previous abdominal surgery.Material and methodsFive hundred and nineteen patients underwent LTA in our center between 2005 and 2016. We identified a study group of 150 patients, with previous abdominal surgery. We analyzed the frequency of intra-operative and post-operative complications and the reasons for conversion from laparoscopic to open adrenalectomy.ResultsThe patients’ mean age was 58; they underwent LTA due to hormonally active tumors (n = 79, 53%) and non-functioning adrenal tumors (n = 71, 47%). The size of adrenal lesions ranged from 20 mm to 90 mm. Seventy-eight (52%) adrenal lesions were found in the right adrenal gland, and 72 (48%) lesions in the left adrenal gland. The mean operating time was 130 min. The mean stay in hospital was five days. The intra-operative complications included blood pressure fluctuations (n = 32), abnormal vascular supply of the adrenal glands causing difficulties with dissections (n = 3), and respiratory problems (n = 1). Two (1.3%) patients had post-operative bleeding at the site of removed adrenal glands; 1 patient had an exacerbation of asthma postoperatively. Of the 150 patients analyzed, 3 (2%) required conversion to open adrenalectomy. The conversions were not caused by abdominal adhesions.ConclusionsLateral transabdominal adrenalectomy is feasible and safe in patients with previous abdominal surgery. In our study, conversion from laparoscopic to open adrenalectomy was not caused by abdominal adhesions.

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Risk factors for complications after adrenalectomy: results from a comprehensive national database

Cited by 55 publications

References 41 publications

Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons' national registry

Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons' national registry

Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center

Lateral laparoscopic adrenalectomy in patients with previous abdominal surgery - single-center experience.

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