Applicability of laparoscopic approach to the resection of large adrenal tumours: a retrospective cohort study on 200 patients

作者：Feo Carlo V; Portinari Mattia^*; Maestroni Umberto; Del Rio Paolo; Severi Silvia; Viani Lorenzo; Pravisani Riccardo; Soliani Giorgio; Zatelli Maria Chiara; Ambrosio Maria Rosaria; Tong Jenny; Terrosu Giovanni; Bresadola Vittorio

来源：Surgical Endoscopy and Other Interventional Techniques, 2016, 30(8): 3532-3540.

DOI：10.1007/s00464-015-4643-6

• Adrenalectomy
• Laparoscopy
• Adrenal cancer
• Cohort study
• Retrospective study
• Multivariate analysis

Controversies exist in the best surgical approach (open vs. laparoscopy) to large adrenal tumours without peri-operative evidence of primary carcinoma, mainly due to possible capsular disruption of an unsuspected malignancy. In addition, intra-operative blood loss, conversion rate, operative time, and hospital stay may be increased with laparoscopy. The aims of our study were: (1) to compare clinical outcomes of laparoscopic adrenalectomy for large versus small adrenal tumours and (2) to identify risk factors associated with increased operative time and hospital stay in laparoscopic adrenalectomy.
This is a multicentre retrospective cohort study in a large patient population (N = 200) who underwent laparoscopic adrenalectomy in 2004-2014 at three Italian academic hospitals. Patients were divided into two cohorts according to tumour size: "large" tumours were defined as aeyen5 cm (N = 50) and "small" tumours as < 5 cm (N = 150). Further analysis adopting a aeyen8 cm (N = 15) cut-off size was performed.
The study groups were comparable in age and gender distribution as well as their tumour characteristics. The operative time (p = 0.671), conversion rate (p = 0.488), intra- (p = 0.876) and post-operative (p = 0.639) complications, and hospital stay (p = 0.229) were similar between groups. With a cut-off size aeyen5 cm, the early study period (2004-2009), which included operators' learning curve, was associated with increased risk of longer operative time (HR 0.57; 95 % CI 0.40-0.82), while American Society of Anaesthesiology score aeyen3 was associated with prolonged hospital stay (HR 0.67; 95 % CI 0.47-0.97). Tumour size aeyen8 cm was associated with prolonged operative time (HR 0.47; 95 % CI 0.24-0.94).
Surgeons skilled in advanced laparoscopy and adrenal surgery can perform laparoscopic adrenalectomy safely in patients with aeyen5-cm tumours with no increase in hospital stay, or conversion rate, although operative time may be increased for aeyen8-cm tumours. Surgeon' experience, size aeyen8 cm, and patient comorbidities have the largest impact on operative time and length of hospital stay in laparoscopic large adrenal tumour resection.

• 出版日期2016-8