Expectations and Outcomes When Moving from Open to Laparoscopic Adrenalectomy: Multivariate Analysis

Abstract

Various authors have suggested that laparoscopic adrenalectomy (LA) leads to better surgical outcomes than open surgery. The debate is still open, however, and indications and limitations of minimally invasive surgery have not been completely established. The objective of our study was to compare surgical outcomes of LA and open adrenalectomy (OA), using multivariate analysis to adjust for potential confounding factors (e.g., size of the lesion, histology). Between 1995 and June 2000 at "Careggi" Hospital in Florence, Italy patients with an indication for adrenalectomy were treated laparoscopically if the lesion was < 10 cm and there was no clinical evidence of malignancy. All 79 patients who underwent LA have been included in this study. Among 152 patients who underwent OA at "La Sapienza" University in Rome, 93 had an adrenal lesion < 10 cm and no clinical evidence of malignancy; they were selected for comparison. Multivariate analysis has been used to analyze the effect of the surgical approach (OA vs. LA) on the surgical outcome, controlling for potential confounders.Multiple logistic regression showed that there is no significant difference in intraoperative outcomes (i.e., surgical time > 2 hours, blood loss ≥ 500 ml) between patients operated on through a traditional approach and those who underwent LA. On the other hand, patients operated on laparoscopically have a significantly higher probability than the OA group of experiencing a better recovery from surgery (i.e., require less postoperative analgesics and return to normal activities earlier). The results of the present study show that, although LA does not add much benefit in terms of expected intraoperative outcomes, it dramatically speeds patients' recovery from surgery. The two approaches are complementary and should both be integrated into the technical background of all endocrine surgeons.

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

“…Contemporary imaging techniques with an increased detection of adrenal incidentalomas and new surgical techniques with reduction of morbidity and mortality with endoscopic methods [1, 2] have contributed to the increase in operations. In 1992, Gagner et al were among the first to describe laparoscopic adrenalectomy [3].…”

“…Since then, several studies have evaluated minimally invasive surgery for adrenal lesions, which has become the standard technique for surgical treatment of adrenal tumours [4, 5]. Previous studies have compared laparoscopic with open adrenalectomy for complications, hospital stay, morbidity and mortality [2, 6, 7]. Laparoscopic adrenalectomy is widely used in both university hospitals and smaller units.…”

Outcomes From 3144 Adrenalectomies in the United States

“…[1][2][3] Another widely cited factor has been laparoscopic adrenalectomy, which is considered to be the new gold standard for adrenal surgery. Several studies [5][6][7][8][33][34][35] comparing laparoscopic with open adrenalectomy for a variety of indications show that the laparoscopic approach leads to decreased complication rates, shorter LOS, and increased patient satisfaction and comfort. The present study confirms that laparoscopic adrenalectomy is associated with lower complication rates, shorter LOS, and lower costs in bivariate and multivariate analyses.…”

Initial experience with laparoscopic posterior retroperitoneal adrenalectomy in single tertiary center

“…Laparoscopic adrenalectomy is known to have the advantages of fewer postoperative complications, bleeding, and analgesic requirements, a shorter hospital stay, and shorter time to return to normal physical activities and diet compared to open adrenalectomy [2,3]. Recently, indications for laparoscopic surgery have been expanded to include metastatic lesions and malignant tumors, and surgical safety for pheochromocytoma has been reported [4][5][6].…”