Advertisement

Surgical Endoscopy

, Volume 27, Issue 7, pp 2342–2350 | Cite as

Risk factors affecting operative approach, conversion, and morbidity for adrenalectomy: a single-institution series of 402 patients

  • James G. BittnerIV
  • Victoria M. Gershuni
  • Brent D. Matthews
  • Jeffrey F. Moley
  • L. Michael Brunt
Article

Abstract

Background

Risk factors for selecting patients for open adrenalectomy (OA) and for conversion are limited in most series. This study aimed to investigate variables that are important in selecting patients for OA, predict risk of conversion from laparoscopic adrenalectomy (LA), and impact 30-day outcomes of OA and LA.

Methods

A retrospective cohort study of prospectively collected data was conducted. Patients (≥16 years old) who underwent adrenalectomy in the Division of General Surgery at Barnes-Jewish Hospital (1993–2010) were grouped by operative approach (LA vs. OA) and compared using nonparametric tests and regression analyses (α < 0.05).

Results

In total, 402 patients underwent 422 adrenalectomies. Compared to LA patients, those in the OA group were older (p = 0.02), had higher ASA scores (p = 0.04), larger tumor size (p < 0.01), and fewer functioning lesions (p < 0.01). OA patients more often required concurrent procedures (p < 0.01), had a longer operative time (p = 0.04), more intraoperative complications (p = 0.02), higher estimated blood loss (EBL), and larger transfusion requirement. Preoperative factors that predicted selection for OA were higher patient age (p = 0.01), higher ASA score (p = 0.03), larger tumor size (p < 0.01), nonfunctioning lesion (p < 0.01), diagnosis of adrenocortical carcinoma (p < 0.01), and the need for concomitant procedures (p < 0.01). Conversion to open or hand-assisted approach occurred in 6.2 % of LA patients. Preoperative risks for conversion included large tumor size (>8 cm) and need for concomitant procedures (p < 0.01). Multivariate analysis revealed that large indeterminate adrenal mass, adrenocortical carcinoma, tumor size (>6 cm), an open operation, conversion, concomitant procedures, operative time >180 min, and EBL >200 mL were predictors of 30-day morbidity.

Conclusions

Adrenal tumor size and need for concurrent procedures significantly impact the selection of patients for OA, the likelihood of conversion, and perioperative morbidity. These metrics should be considered when assessing operative approach and risks for adrenalectomy.

Keywords

Adrenalectomy Open adrenalectomy Laparoscopic adrenalectomy Conversion Risk factors 

Notes

Acknowledgments

The authors recognize Mary Quasebarth, RN, for her assistance with IRB protocol submission. James G. Bittner IV, MD, is supported by an MIS Clinical Fellowship educational grant from the Foundation for Surgical Fellowships.

Disclosures

James G. Bittner IV, MD, and L. Michael Brunt, MD, has received honoraria from Ethicon Endo-Surgery, Inc. for teaching and speaking. Brent D. Matthews, MD, is a consultant for Atrium Medical Corporation and Ethicon, Inc. He has received honoraria and research/equipment support from Atrium Medical Corporation, Ethicon Endo-Surgery, Inc., Karl Storz Endoscopy, Stryker Endoscopy, and W.L. Gore & Associates, Inc. Victoria M. Gershuni, MS, and Jeffrey F. Moley, MD, have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1033PubMedCrossRefGoogle Scholar
  2. 2.
    Brunt LM, Doherty GM, Norton JA, Soper NJ, Quasebarth MA et al (1996) Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg 183:1–10PubMedGoogle Scholar
  3. 3.
    Brunt LM, Moley JF, Doherty GM, Lairmore TC, DeBenedetti MK et al (2001) Outcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors. Surgery 130:629–634 (discussion 634–625)Google Scholar
  4. 4.
    Brunt LM (2002) The positive impact of laparoscopic adrenalectomy on complications of adrenal surgery. Surg Endosc 16:252–257PubMedCrossRefGoogle Scholar
  5. 5.
    Murphy MM, Witkowski ER, Ng SC, McDade TP, Hill JS et al (2010) Trends in adrenalectomy: a recent national review. Surg Endosc 24:2518–2526PubMedCrossRefGoogle Scholar
  6. 6.
    Lee J, El-Tamer M, Schifftner T, Turrentine FE, Henderson WG et al (2008) Open and laparoscopic adrenalectomy: analysis of the National Surgical Quality Improvement Program. J Am Coll Surg 206:953–959; discussion 959–961Google Scholar
  7. 7.
    Henneman D, Chang Y, Hodin RA, Berger DL (2009) Effect of laparoscopy on the indications for adrenalectomy. Arch Surg 144:255–259; discussion 259Google Scholar
  8. 8.
    Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250:177–186PubMedCrossRefGoogle Scholar
  9. 9.
    Walz MK, Alesina PF, Wenger FA, Deligiannis A, Szuczik E et al (2006) Posterior retroperitoneoscopic adrenalectomy—results of 560 procedures in 520 patients. Surgery 140:943–948 (discussion 948–950)Google Scholar
  10. 10.
    Nguyen PH, Keller JE, Novitsky YW, Heniford BT, Kercher KW (2011) Laparoscopic approach to adrenalectomy: review of perioperative outcomes in a single center. Am Surg 77:592–596PubMedGoogle Scholar
  11. 11.
    Gupta PK, Natarajan B, Pallati PK, Gupta H, Sainath J et al (2011) Outcomes after laparoscopic adrenalectomy. Surg Endosc 25:784–794PubMedCrossRefGoogle Scholar
  12. 12.
    Brunt LM, Lairmore TC, Doherty GM, Quasebarth MA, DeBenedetti M et al (2002) Adrenalectomy for familial pheochromocytoma in the laparoscopic era. Ann Surg 235:713–720; discussion 720–711Google Scholar
  13. 13.
    Mazzaglia PJ, Vezeridis MP (2010) Laparoscopic adrenalectomy: balancing the operative indications with the technical advances. J Surg Oncol 101:739–744PubMedCrossRefGoogle Scholar
  14. 14.
    Asari R, Koperek O, Niederle B (2012) Endoscopic adrenalectomy in large adrenal tumors. Surgery 152(1):41–49PubMedCrossRefGoogle Scholar
  15. 15.
    Perry KA, El Youssef R, Pham TH, Sheppard BC (2010) Laparoscopic adrenalectomy for large unilateral pheochromocytoma: experience in a large academic medical center. Surg Endosc 24:1462–1467PubMedCrossRefGoogle Scholar
  16. 16.
    Boylu U, Oommen M, Lee BR, Thomas R (2009) Laparoscopic adrenalectomy for large adrenal masses: pushing the envelope. J Endourol 23:971–975PubMedCrossRefGoogle Scholar
  17. 17.
    Ippolito G, Palazzo FF, Sebag F, Thakur A, Cherenko M et al (2008) Safety of laparoscopic adrenalectomy in patients with large pheochromocytomas: a single institution review. World J Surg 32:840–844 (discussion 845–846)Google Scholar
  18. 18.
    Novitsky YW, Czerniach DR, Kercher KW, Perugini RA, Kelly JJ et al (2003) Feasibility of laparoscopic adrenalectomy for large adrenal masses. Surg Laparosc Endosc Percutan Tech 13:106–110PubMedCrossRefGoogle Scholar
  19. 19.
    Kazaure HS, Roman SA, Sosa JA (2011) Adrenalectomy in older Americans has increased morbidity and mortality: an analysis of 6,416 patients. Ann Surg Oncol 18:2714–2721PubMedCrossRefGoogle Scholar
  20. 20.
    Gaujoux S, Bonnet S, Leconte M, Zohar S, Bertherat J et al (2011) Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy. Br J Surg 98:1392–1399PubMedCrossRefGoogle Scholar
  21. 21.
    Shen ZJ, Chen SW, Wang S, Jin XD, Chen J et al (2007) Predictive factors for open conversion of laparoscopic adrenalectomy: a 13-year review of 456 cases. J Endourol 21:1333–1337PubMedCrossRefGoogle Scholar
  22. 22.
    Shen WT, Kebebew E, Clark OH, Duh QY (2004) Reasons for conversion from laparoscopic to open or hand-assisted adrenalectomy: review of 261 laparoscopic adrenalectomies from 1993 to 2003. World J Surg 28:1176–1179PubMedCrossRefGoogle Scholar
  23. 23.
    Maccabee DL, Jones A, Domreis J, Deveney CW, Sheppard BC (2003) Transition from open to laparoscopic adrenalectomy: the need for advanced training. Surg Endosc 17:1566–1569PubMedCrossRefGoogle Scholar
  24. 24.
    Kazaure HS, Roman SA, Sosa JA (2011) Obesity is a predictor of morbidity in 1,629 patients who underwent adrenalectomy. World J Surg 35:1287–1295PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • James G. BittnerIV
    • 1
  • Victoria M. Gershuni
    • 1
  • Brent D. Matthews
    • 1
  • Jeffrey F. Moley
    • 1
  • L. Michael Brunt
    • 1
  1. 1.Section of Minimally Invasive Surgery, Department of SurgeryWashington University School of MedicineSt. LouisUSA

Personalised recommendations