Comparison of the retroperitoneal laparoscopic adrenalectomy versus transperitoneal laparoscopic adrenalectomy for large (≥6cm) pheochromocytomas: A single-centre retrospective study

Lei, Kunyang; Wang, Xu; Yang, Zhongsheng; Liu, Yifu; Sun, Ting; Xie, Wenjie; Ma, Mengmeng

doi:10.3389/fonc.2023.1043753

Cited by 2 publications

(3 citation statements)

References 30 publications

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“…These lesions were both pheochromocytomas on histopathology, with one only diagnosed post-operatively. The higher PRA pheochromocytomas-related conversion rates observed in this study contradicted findings reported by Hisano M et al [ 28 ] and Lei K et al [ 29 ]; this could be due to bias, given this study's low overall conversion rate. Some studies have suggested that the measurement of retroperitoneal fat mass in preoperative CT can predict conversion rate [ 30 ].…”

Section: Discussioncontrasting

confidence: 90%

The Impact of Obesity on Mortality and Complications in Posterior Retroperitoneoscopic Adrenalectomy

Seow¹,

Nyandoro²,

Poh³

et al. 2023

Cureus

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Background Obesity is a global epidemic. It influences surgical technique, ergonomics, safety, and outcomes. However, there is a paucity of evidence of obesity-related impact in posterior retroperitoneoscopic adrenalectomy (PRA). This study compared perioperative outcomes of obese and non-obese participants undergoing PRA. Methodology This is a multi-center retrospective cohort study of elective PRA from March 2014 to December 2022. Patient demographics, surgical techniques, clinicopathological parameters, and outcomes, including overall complication rate, were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results Seventy-five patients underwent a PRA, of which 97.3% were completed retroperitoneoscopically. The overall complication rate was (9.3%), and on subgroup analysis, the obese cohort had a lower percentage complication profile at 6.5%. Male participants comprised 52%, with a median age of 55 (IQR=19). The median BMI was 29.0 (IQR=8), of which 41% were obese, and 40% were overweight. Univariate analysis showed that being obese was not significantly associated with a higher complication rate (p=0.471). In addition, there was no significant increase in conversion (p=0.508), bleeding/transfusion (p=0.508), surgical site infection (SSI; p=1.000), incisional hernia (p=1.000), ICU or high dependency unit admission (p=0.292) and any-cause mortality (p=1.000). No sentinel deaths directly related to PRA were recorded. Procedure duration was longer in obese (117 mins) vs. non-obese participants (88.9 mins, p=0.022). However, there was no significant difference in the length-of-hospital stay (p=0.592). The cohort conversion rate was (2.7%), and tumor size was associated with a higher conversion rate (35.4 vs. 62.5mm, p=0.040). Conclusion Posterior retroperitoneoscopic adrenalectomy can be a safe procedure in obese populations, and obesity does not increase perioperative morbidity or mortality.

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Section: Discussioncontrasting

confidence: 90%

The Impact of Obesity on Mortality and Complications in Posterior Retroperitoneoscopic Adrenalectomy

Seow¹,

Nyandoro²,

Poh³

et al. 2023

Cureus

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“…The application of RLA for managing LATs remains a challenging and contentious topic. Lei et al (14) and Shiraishi et al (15) shared their experiences using TLA and RLA to treat large pheochromocytomas. Their findings demonstrated that RLA was superior to TLA, yielding reduced operation time, less EBL, quicker time to ambulation, earlier time to oral intake, and shorter hospital stays (14,15).…”

Section: Discussionmentioning

confidence: 99%

“…Lei et al (14) and Shiraishi et al (15) shared their experiences using TLA and RLA to treat large pheochromocytomas. Their findings demonstrated that RLA was superior to TLA, yielding reduced operation time, less EBL, quicker time to ambulation, earlier time to oral intake, and shorter hospital stays (14,15). This aligns with the outcomes highlighted in the aforementioned systematic review (9,13).…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal laparoscopic adrenalectomy for large adrenal tumors—analysis of tumor size and adverse events: a retrospective single-center study

Tsai,

Hsieh,

Tseng

et al. 2024

Front. Surg.

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IntroductionAdrenal tumors are relatively common, and adrenalectomy is the third most common endocrine surgery. Patients with adrenal tumors were categorized into two groups for analysis: those with intermediate (4–6 cm, Group 1) and large (>6 cm, Group 2) tumors undergoing Retroperitoneal Laparoscopic Adrenalectomy (RLA). The primary outcome is to compare the surgical outcomes between these two groups. The secondary outcome involves analyzing the relationship between tumor characteristics and the incidence of adverse events.MethodsData from 76 patients who underwent RLA for tumors of size ≥4 cm between 2005 and 2022 at a single tertiary referral center were analyzed retrospectively. Variables, including patients' age, hormone function, operation time, conversion to open approach, perioperative complications, and adverse surgical events (blood loss >500 cc, conversion to open approach, and perioperative complications), were assessed.ResultsNo significant differences were observed between the two groups in terms of functional and histopathologic analysis, gender distribution, functioning factors, perioperative complications, and estimated blood loss. However, patients in Group 2 were younger (median age 50, IQR: 40–57, P = 0.04), experienced longer operative times (median 175 min, IQR: 145–230 min, P = 0.005), and had a higher rate of conversion to open surgery (12%, P = 0.033). For every 1 cm increase in tumor size, the odds ratio for adverse surgical events increased by 1.58.ConclusionsRLA is a safe and feasible procedure for adrenal tumors larger than 6 cm. While intraoperative and postoperative complications are not significantly increased in either group, larger tumors increase surgery times and are more likely to require conversion to open surgery. Therefore, caution and preparedness for potential adverse events are recommended when dealing with larger tumors. A tumor size of 5.3 cm may serve as a guide for risk stratification and surgical planning in large adrenal tumor management.

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Comparison of the retroperitoneal laparoscopic adrenalectomy versus transperitoneal laparoscopic adrenalectomy for large (≥6cm) pheochromocytomas: A single-centre retrospective study

Cited by 2 publications

References 30 publications

The Impact of Obesity on Mortality and Complications in Posterior Retroperitoneoscopic Adrenalectomy

The Impact of Obesity on Mortality and Complications in Posterior Retroperitoneoscopic Adrenalectomy

Retroperitoneal laparoscopic adrenalectomy for large adrenal tumors—analysis of tumor size and adverse events: a retrospective single-center study

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