Development and validation of a preoperative “difficulty score” for laparoscopic transabdominal adrenalectomy: a multicenter retrospective study

Abstract

Background A difficulty score for laparoscopic adrenalectomy (LA) is lacking in the literature. A retrospective cohort study was designed to develop a preoperative “difficulty score” for LA. Methods A multicenter study was conducted involving four Italian tertiary centers for adrenal disease. The population was randomly divided into two subsets: training group and validation one. A multicenter study was undertaken, including 964 patients. Patient, adrenal lesion, surgeon’s characteristics, and the type of procedure were studied as potential predictors of target events. The operative time (pOT), conversion rate (cLA), or both were used as indicators of the difficulty in three multivariate models. All models were developed in a training cohort (70% of the sample) and validated using 30% of patients. For all models, the ability to predict complicated postoperative course was reported describing the area under the curve (AUCs). Logistic regression, reporting odds ratio (OR) with p-value, was used. Results In model A, gender (OR 2.04, p = 0.001), BMI (OR 1.07, p = 0.002), previous surgery (OR 1.29, p = 0.048), site (OR 21.8, p < 0.001) and size of the lesion (OR 1.16, p = 0.002), cumulative sum of procedures (OR 0.99, p < 0.001), extended (OR 26.72, p < 0.001) or associated procedures (OR 4.32, p = 0.015) increased the pOT. In model B, ASA (OR 2.86, p = 0.001), lesion size (OR 1.20, p = 0.005), and extended resection (OR 8.85, p = 0.007) increased the cLA risk. Model C had similar results to model A. All scores obtained predicted the target events in validation cohort (OR 1.99, p < 0.001; OR 1.37, p = 0.007; OR 1.70, p < 0.001, score A, B, and C, respectively). The AUCs in predicting complications were 0.740, 0.686, and 0.763 for model A, B, and C, respectively. Conclusion A difficulty score based on both pOT and cLA (Model C) was developed using 70% of the sample. The score was validated using a second cohort. Finally, the score was tested, and its results are able to predict a complicated postoperative course.

A nomogram for evaluation and analysis of difficulty in retroperitoneal laparoscopic adrenalectomy: A single-center study with prospective validation using LASSO-logistic regression

“…As another factor, while BMI is used to evaluate degree of obesity, it primarily reflects body fat composition, and the distribution of visceral fat, especially perirenal fat, may differ. Therefore, the prediction of BMI on difficulty of RPLA is still controversial, with a limited number of studies suggesting that BMI has a significant impact (1,14,21).…”

“…Laparoscopic surgery is further divided into transperitoneal laparoscopic adrenalectomy (TPLA) and retroperitoneal laparoscopic adrenalectomy (RPLA), with TLPA first competed in 1992 by Gagner et al (9) and Higashihara et al (10) and RPLA first proposed by Gaur et al (11), later refined by Walz et al (12). Compared with TLPA, RPLA has less postoperative pain, fewer complications, and lower incidence of intraoperative adverse events such as hemodynamic instability and massive bleeding (13,14). However, there is currently no effective evaluation system for the difficulties of RPLA.…”

Perioperative factors influencing the difficulty of retroperitoneal laparoscopic adrenalectomy: a single-center retrospective study

“…Creation of such a scoring system would help to guide the selection of surgical methods and predicting the difficulty of surgery. In 2021, Alberici et al devised a scoring method that could be used to predict the difficulty of transabdominal laparoscopic adrenalectomy using three models and found that this score could also predict a complicated postoperative course [ 7 ]. Furthermore, Vrielinkom et al reported that retroperitoneal laparoscopic adrenalectomy could reduce the operating time, amount of blood loss, and complication rate in comparison with transabdominal laparoscopic adrenalectomy [ 8 ].…”

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

“…7,19,20 Adrenal mass size represents one of the major factors in the selection of the surgical approach, and a predictor of difficulty, conversion, and complications. 15,[21][22][23][24] Previous reports suggested that the cutoff for performing a minimal invasive approach is <6 cm due to the increased risk of malignancy. 4,13,[25][26][27] More recent reports on the feasibility and safety of performing larger size masses up to 12 cm, [27][28][29][30][31] especially in the era of robotic surgery, with growing evidence to support its safety.…”

“…Adrenal mass size represents one of the major factors in the selection of the surgical approach, and a predictor of difficulty, conversion, and complications 15,21–24. Previous reports suggested that the cutoff for performing a minimal invasive approach is <6 cm due to the increased risk of malignancy 4,13,25–27.…”