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

Abstract

Background: Since the introduction of laparoscopic adrenalectomy (LA) in 1992, it has become the standard of care for most adrenal benign pathologies. This study compares the outcomes and trends of open (OA) versus LA in veterans for benign pathologies.Methods: Veterans Affairs Surgical Quality Improvement Program was queried for adrenalectomies performed for benign pathologies during the period 2000-2019. Data collection included demographics, comorbidities, operative details, and postoperative outcomes.Results: A total of 1683 patients were included (91.4% males, mean age 59.6, mean body mass index 31.2, and 87.2% with American Society of Anesthesiologists class ≥ III). Overall, the mean operative time (OT) was 3.2 hours, the majority performed by general surgeons (71.4%), and the mean length of stay (LOS) was 4.1 days. There were 12 (0.7%) 30-day mortalities, and 162 patients (8.8%) developed ≥ 1 complication. LA was performed in 70.9% ( 1306), with the conversion rate of 0.85% (10). When compared with OA, patients with the laparoscopic approach were functionally independent, shorter OT, less intraoperative blood transfusion, shorter LOS, and lower mortality and morbidity. Dependent functional status, congestive heart failure, American Society of Anesthesiologists class ≥ III, and smoking were independent predictors of mortality, whereas intraoperative transfusions, chronic obstructive pulmonary disease, and dependent functional status were predictors of morbidity. Trend analysis showed an 8-fold increase in the use of LA. However, trend analysis for morbidity and mortality rates showed no significant change for both approaches. Conclusion:LA is being well adopted in the veterans affairs system with an 8-fold increase over 20 years, with lower morbidity and mortality compared with the open approach for benign adrenal pathologies.

A 15-cm Adrenal Incidentaloma Suggested on Upper Endoscopy and Resected Laparoscopically

“…The benefits of the minimally-invasive approach were proved in many previous works. In their study of 1683 adrenalectomy patients, Shahait et al showed that laparoscopic adrenalectomy was associated with lower morbidity and mortality, shorter length of stay, and less blood loss compared with the open approach [14]. In their retrospective analysis, Mohammed et al proved that there is no priority of the open approach in adrenal tumors that are 5 cm or larger concerning complication rate, length of stay, mortality, or oncologic outcomes.…”

“…Robotic-assisted resection was also recommended in more difficult cases or larger tumors, as it may provide the needed dexterity for handling such tumors [16]. Therefore, it is no wonder that the use of minimally invasive adrenalectomy is on the rise, with trend analysis showing an increase of eight-fold over a period of 20 years [14].…”

Surgical approaches to the adrenal gland

“…The rate of performed adrenalectomies has been increasing with the increased adoption of minimally invasive surgical approaches and the widespread utilization of cross-sectional images [1][2][3]. A recent study using the Veterans Affairs Surgical Quality Improvement Program found that the rate of laparoscopic adrenalectomy has increased eight-fold over the last 20 years [2]. Not only has the rate of performed adrenalectomies continued to raise, but also the rate of implementing minimally invasive techniques in adrenal surgery.…”