Konstantinos P Economopoulos1, Roy Phitayakorn1, Carrie C Lubitz1, Peter M Sadow2, Sareh Parangi1, Antonia E Stephen1, Richard A Hodin3. 1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 2. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 3. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: rhodin@mgh.harvard.edu.
Abstract
BACKGROUND: Although laparoscopic transperitoneal adrenalectomy (LTA) has become a standard operative approach to patients with benign adrenal masses, some authors have suggested that LTA should be avoided in obese patients, patients who have had previous abdominal surgery, and in cases of bilateral adrenalectomy. We sought to determine whether LTA in these clinical situations is associated with worse outcomes. METHODS: Consecutive patients who underwent LTA at a tertiary care center (1/2002-8/2014) were reviewed retrospectively. Study endpoints included operative time, duration of stay, conversion to open procedure, and postoperative complications. Statistical analyses were performed by use of Wilcoxon rank sum test, Kruskal-Wallis test, Fisher exact test, χ(2) test, and binary logistic regression analyses. RESULTS: A total of 365 patients had a planned LTA, 6 of whom were converted to an open adrenalectomy. Obesity, history of previous abdominal surgery, and bilateral adrenalectomy were not associated with greater conversion rates or postoperative complications. Male sex, tumor size ≥ 4 cm and obesity (body mass index ≥ 30 kg/m(2)) were significant factors associated with increased operative time. Bilateral adrenalectomy, age, and pheochromocytomas were associated with increased hospital stays. CONCLUSION: Obesity, history of prior abdominal surgery and bilateral adrenalectomy should not be used to discourage experienced adrenal surgeons from performing LTA.
BACKGROUND: Although laparoscopic transperitoneal adrenalectomy (LTA) has become a standard operative approach to patients with benign adrenal masses, some authors have suggested that LTA should be avoided in obesepatients, patients who have had previous abdominal surgery, and in cases of bilateral adrenalectomy. We sought to determine whether LTA in these clinical situations is associated with worse outcomes. METHODS: Consecutive patients who underwent LTA at a tertiary care center (1/2002-8/2014) were reviewed retrospectively. Study endpoints included operative time, duration of stay, conversion to open procedure, and postoperative complications. Statistical analyses were performed by use of Wilcoxon rank sum test, Kruskal-Wallis test, Fisher exact test, χ(2) test, and binary logistic regression analyses. RESULTS: A total of 365 patients had a planned LTA, 6 of whom were converted to an open adrenalectomy. Obesity, history of previous abdominal surgery, and bilateral adrenalectomy were not associated with greater conversion rates or postoperative complications. Male sex, tumor size ≥ 4 cm and obesity (body mass index ≥ 30 kg/m(2)) were significant factors associated with increased operative time. Bilateral adrenalectomy, age, and pheochromocytomas were associated with increased hospital stays. CONCLUSION:Obesity, history of prior abdominal surgery and bilateral adrenalectomy should not be used to discourage experienced adrenal surgeons from performing LTA.
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