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Not all laparoscopic adrenalectomies are equal: analysis of postoperative outcomes based on tumor functionality

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Abstract

Background

Laparoscopic adrenalectomy is known to have a low complication rate; however, the influence of functional tumor subtype on postoperative outcomes is not well defined.

Methods

Patients undergoing laparoscopic adrenalectomy for benign adrenal tumors between 2009 and 2017 were selected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patient demographics, postoperative outcomes, and length of stay were compared between tumor subtypes.

Results

A total of 3946 patients underwent a laparoscopic adrenalectomy during the study period; 3214 (81.5%) were performed for non-functional adenomas, and 732 (18.6%) for functional tumors—467 (64%) aldosteronomas, 184 (25%) cortisol-producing adenomas, and 81 (11%) pheochromocytomas. The risk of any complication was highest for patients with Cushing’s (6.5%) and lowest with Conn’s syndrome (1.1%) compared to other lesions (3.7% pheochromocytoma, 5.3% adenoma, p < 0.001). Among the patients with functional tumors, those with cortisol-producing adenomas had the highest rates of both deep surgical site infection (1.6%, p = 0.026) and urinary tract infection (2.2%, p = 0.029), whereas myocardial infarction was most prevalent in patients with pheochromocytoma (2.5%, p = 0.012). When adjusted for demographic differences, BMI, and comorbidity scores, no tumor type was associated with increased complication rate; instead aldosteronoma (vs. benign adenoma) was independently predictive of fewer adverse events [0.3 (95% CI 0.1–0.7), p = 0.004] and a shorter length of hospital stay [0.6 (95% CI 0.4–0.8), p = 0.001]. The overall mortality rate was low at 0.4%, although significantly higher in Cushing’s patients (2.2%, p = 0.015).

Conclusions

Laparoscopic adrenalectomy is a safe operation with low mortality and complication rates. However, postoperative risks differ between tumor subtype, so patients should be counseled accordingly.

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Authors and Affiliations

  1. Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 1300 York Ave, New York, NY, USA

    Jessica Limberg, Dessislava Stefanova, Timothy M. Ullmann, Jessica W. Thiesmeyer, Jessica L. Buicko, Brendan M. Finnerty, Rasa Zarnegar, Thomas J. Fahey III & Toni Beninato

Authors
  1. Jessica Limberg
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  2. Dessislava Stefanova
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  3. Timothy M. Ullmann
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  4. Jessica W. Thiesmeyer
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  5. Jessica L. Buicko
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  7. Rasa Zarnegar
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Corresponding author

Correspondence to Jessica Limberg.

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Disclosures

Dr. Zarnegar is a paid consultant for BDI Surgical, Becton Dickinson and Company. Drs. Limberg, Stefanova, Ullmann, Thiesmeyer, Buicko, Finnerty, Fahey, and Beninato have no conflicts of interest or financial ties to disclose.

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Meeting presentation

This analysis was presented as a quick-shot oral presentation at the annual American College of Surgeons meeting in October, 2019 in San Francisco, CA.

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Limberg, J., Stefanova, D., Ullmann, T.M. et al. Not all laparoscopic adrenalectomies are equal: analysis of postoperative outcomes based on tumor functionality. Surg Endosc 35, 2601–2606 (2021). https://doi.org/10.1007/s00464-020-07678-2

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  • DOI: https://doi.org/10.1007/s00464-020-07678-2

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