Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy

Gaujoux, Sébastien; Bonnet, Stéphane; Leconte, Mahaut; Zohar, Sarah; Bertherat, Jérôme; Bertagna, Xavier; Dousset, B.

doi:10.1002/bjs.7558

Cited by 82 publications

(54 citation statements)

References 63 publications

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“…28 Compared with other adrenal gland tumors, PCC has been associated with a lower conversion rate (by approximately 10%), 29 but the exact figure has been remarkably different among previous studies. [30][31][32] Tumor size is thought to be a primary, independent risk factor contributing to conversion.…”

Section: Commentsmentioning

confidence: 94%

Effectiveness and safety of laparoscopic adrenalectomy of large pheochromocytoma: a prospective, nonrandomized, controlled study

Wang

Ping

Wang

et al. 2015

The American Journal of Surgery

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Section: Commentsmentioning

confidence: 94%

Effectiveness and safety of laparoscopic adrenalectomy of large pheochromocytoma: a prospective, nonrandomized, controlled study

Wang

Ping

Wang

et al. 2015

The American Journal of Surgery

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“…Laparoscopic adrenalectomy has become the ''gold standard'' for the treatment of average sized (< 6 cm) adrenal lesions (whether secreting or not), but it has also been proposed in recent years for larger or for small but potentially malignant tumors with no evidence of invasion [45][46][47][48][49][50]. Large adrenocortical tumors (> 10 cm) and/or lesions that invade adjacent structures (Stage 3) are the only indications for an immediate open laparotomy [48].…”

Section: Surgery Different Surgical Approachesmentioning

confidence: 99%

Management of adrenal incidentaloma

Ménégaux

Chéreau

Peix

et al. 2014

Journal of Visceral Surgery

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Improvements in medical imaging have resulted in the incidental discovery of many silent and unrecognized adrenal tumors. The term "adrenal incidentaloma" (AI) is applied to any adrenal mass≥1cm in its longest axis that is discovered incidentally during abdominal imaging that was not performed to specifically evaluate adrenal pathology. These incidentalomas may be either secretory or non-secretory, benign or malignant. Distinctive characteristics of these lesions must be determined by the clinician to determine appropriate management. Such distinctions are based on laboratory findings and imaging, principally CT with and without contrast injection. Investigations must be carefully chosen to avoid ordering unnecessary and expensive tests for too many patients while, at the same time, avoiding the risk of failing to diagnose a secreting malignant or tumor. These examinations will determine patient care: surgery or surveillance. When simple surveillance is chosen, specific criteria must be met with regard to diagnostic modalities (clinical, imaging, laboratory testing) and its duration.

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“…Studies have evaluated risk factors for complications associated with surgical technique, surgeon volume and patient-related risk factors. Most of the studies are single-centre studies [8–10], although a few national studies that included specific hospitals or patient groups are available [11–13]. …”

Section: Introductionmentioning

confidence: 99%

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

Thompson

Nordenström

Almquist

et al. 2016

Langenbecks Arch Surg

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PurposeMost knowledge regarding outcome after adrenal surgery stems from retrospective studies reported by highly specialized centres. The aim of this study was to report a national experience of adrenalectomy with particular attention to predictive factors for postoperative complications, conversion from endoscopic to open surgery and length of hospital stay.MethodsAdrenalectomies reported in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) 2009–2014 were included. Risk factors for complications, conversion and hospital stay >3 days were assessed using univariable and multivariable logistic regression analysis.ResultsThere were 659 operations. Endoscopic adrenalectomy was performed in 513 (77.8%) operations and almost half of these were robotic assisted. The median length of hospital stay was 3 (range 1–30) days. There was no 30-day mortality. In 43 (6.6%) patients, at least one complication was registered. The only factor associated with complications in multivariable analysis was conversion to open surgery odds ratio (OR) 3.61 (95% confidence interval 1.07 to 12.12). The risk for conversion was associated with tumour size OR 1.03 (1.00 to 1.06) and with malignancy on histopathology OR 8.33 (2.12 to 32.07). Length of hospital stay increased in patients with operation of bilateral tumours OR 3.13, left-sided tumours OR 1.98, hyper secretion of catecholamines OR 2.32, conversion to open surgery OR 42.05 and open surgery OR 115.18.ConclusionsThe present study shows that endoscopic surgery is widely used. Complications were associated with conversion and the risk for conversion was associated with tumour size and malignant tumour. Hospital stay was short.Electronic supplementary materialThe online version of this article (doi:10.1007/s00423-016-1535-8) contains supplementary material, which is available to authorized users.

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Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy

Abstract: In this single-institution study, conversion to open surgery and left-sided tumours were independent predictive factors for overall complications, but none of the variables analysed was predictive of conversion.

Cited by 82 publications

References 63 publications

Effectiveness and safety of laparoscopic adrenalectomy of large pheochromocytoma: a prospective, nonrandomized, controlled study

Effectiveness and safety of laparoscopic adrenalectomy of large pheochromocytoma: a prospective, nonrandomized, controlled study

Management of adrenal incidentaloma

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

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