Introduction: Laparoscopic adrenalectomy has become the gold standard procedure for benign adrenal tumor; and the application of laparoscopic adrenalectomy has expanded to malignant adrenal tumor. Although several studies reported various preoperative predictors for perioperative outcomes of laparoscopic adrenalectomy, their conclusions were inconsistent. We investigated the preoperative predictive factors related to perioperative outcomes in 205 cases of laparoscopic adrenalectomy in a single institution.
Methods: We retrospectively reviewed perioperative outcomes from the medical records of 205 consecutive patients who underwent transabdominal laparoscopic adrenalectomy between January 2006 and March 2021. The preoperative factors associated with perioperative outcomes were statistically analyzed.
Results: A total of 111 and 98 patients were female (53.1%) and male (46.9%), respectively. The median patient age was 54 years (range: 17–88 years), and median body mass index was 23.2 (range: 15.5–42.9). Among these patients, 184 and 25 were preoperatively suspected as having benign and malignant adrenal tumor, respectively. The median tumor size was 25 mm (range: 5–90 mm) and median perirenal fat thickness was 8.55 mm (range: 1.09–34.47 mm). The median operation time was 148 min (range: 71–400 min) and mean amount of bleeding was 43 ml (range: 0–1450 ml). Blood transfusion was required in 1 case, and intraoperative open conversion was performed in 4 cases. Sixteen patients experienced postoperative complications (Clavien-Dindo classification, grade 1–2: 13 cases, grade 3: 3 cases). Multivariate analysis revealed that perirenal fat thickness and tumor size were significantly related to prolonged operation time (P < 0.001, P = 0.002) and amount of bleeding (P < 0.001, P = 0.002), respectively.
Conclusions: We showed perirenal fat thickness and tumor size were strongly associated with perioperative outcomes of laparoscopic adrenalectomy. This finding is meaningful for surgeons who perform or instruct laparoscopic adrenalectomy. In addition, the distinction of benign or malignant tumor was not statistically related to operation time and bleeding. This suggests that laparoscopic adrenalectomy for both benign and malignant adrenal tumor can be performed safely.
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