Laparoscopic adrenalectomy: pathologic features determine outcome

• Published in: Canadian Journal of Surgery 2003-10, Vol.46 (5), p.340-344
• Main Authors: Poulin, Eric C, Schlachta, Christopher M, Burpee, Stephen E, Pace, Kenneth T, Mamazza, Joseph
• Format: Article
• Language: English
• Subjects: Adenoma - surgery; Adrenal Cortex Neoplasms - surgery; Adrenal Gland Neoplasms - surgery; Adrenal glands; Adrenalectomy; Adult; Age Factors; Aged; Aged, 80 and over; Blood Loss, Surgical; Body Weight; Cushing Syndrome - surgery; Female; Humans; Hyperaldosteronism - surgery; Laparoscopy; Length of Stay; Longitudinal Studies; Male; Microsurgery; Middle Aged; Original; Paraganglioma - surgery; Patient Selection; Pheochromocytoma - surgery; Postoperative Complications; Time Factors; Treatment Outcome
• ISSN: 0008-428X; 1488-2310

The differential outcomes of laparoscopic adrenalectomy are not well described. Therefore, we evaluated these outcomes in the 3 groups most often seen clinically: bilateral adrenalectomy for Cushing's disease (group 1), pheochromocytoma (group 2) and unilateral adrenalectomy for non-pheochromocytoma (group 3). We reviewed a longitudinal database of 72 consecutive cases of laparoscopic adrenalectomy carried out between 1997 and 2001 at the Centre for Minimally Invasive Surgery, University of Toronto. Patients in group 1 tended to be older (median 49 yr) and heavier (median 87 kg). They had a longer operating time (median 255 min), more postoperative complications (15%) and a longer median postoperative stay (4 d). Patients in group 2 had intermediate outcomes: a median operating time of 198 minutes, complication rate of 8.3% and a median postoperative hospital stay of 3 days. However, they had more intraoperative blood loss (median 150 mL). Group 3 patients had the best outcomes with the shortest median operating time (125 min), least blood loss (median 50 mL), fewer complications (6%) and shortest hospital stay (median 2 d). Although the outcomes of laparoscopic adrenalectomy are uniformly good, on the basis of the underlying pathologic characteristics, patients can be divided into groups that have different expected outcomes. Patients requiring a unilateral adrenalectomy except for pheochromocytoma have the best recorded outcomes. Surgeons transferring to laparoscopic adrenalectomy would benefit from selecting patients in this group during their learning curve.