Adrenal kitlelerde laparaskopik ve açık cerrahi tekniklerin sonuç açısından karşılaştırılması

Year 2019, Volume: 44 Issue: Supplement 1, 391 - 399, 29.12.2019

Kubilay Dalcı Uğur Topal , Ayşe Gizem Ünal İsmail Cem Eray Orçun Yalav , Gürhan Sakman

https://doi.org/10.17826/cumj.570824

Abstract

 Amaç: Bu çalışmada, 9 yıl içerisinde adrenal kitle nedeni ile ameliyat edilen olgularda konvansiyonel ve laparoskopik adrenalektominin sonuçlarının karşılaştırılması amaçlanmıştır.

Gereç ve Yöntem: Adrenalektomi uygulanan 81 hasta çalışmaya dahil edildi. Grup 1 konvansiyonel, Grup 2 Laparaskopik cerrahi olarak hastalar iki grupa ayrıldı. İki grup, yaş, cinsiyet, vücut kitle indeksi (VKİ), Amerikan anestezistler derneği skoru (ASA), kitle lokalizasyonu, kitle büyüklüğü ve kitlenin hormonal aktivitesi, operasyon süresi, operasyonda kanama miktarı, yatış süresi, gıdaya başlama süresi, perioperatif mortalite, erken dönem komplikasyonlar ve 90 gün içinde hastaneye tekrar başvuru gibi özellikleri esas alınarak retrospektif olarak karşılaştırıldı. 

Bulgular: Grup 1’de 22, Grup 2’de 59 hasta mevcut idi. Gruplar arasında yaş, cinsiyet, VKİ, ASA skoru, tümör lokalizasyonu, operasyon endikasyonları, postoperatif komplikasyon, perioperatif mortalite ve 90 gün içinde tekrar başvuru açısından istatistiksel olarak anlamlı fark saptanmadı. Kitlenin hormonal aktivitesi Grup 2’de daha yüksek, boyutu ise daha küçük saptandı. Operasyon süresi (dak), ameliyatta kanama miktarı (ml), oral alım süresi (gün) ve hastanede yatış süresi (gün) Grup 1’de daha fazla ve istatiksel olarak anlamlı bulundu. 

Sonuç: Laparoskopik adrenalektomi uygun hastalarda, kısa operasyon süresi, az kan kaybı, oral gıdaya erken başlama süresi ve daha kısa hastanede kalış süresi gibi avantajları, ayrıca güvenli olması nedeni ile tercih edilmesi gereken cerrahi yöntem olmalıdır.

Keywords

sürrenal, laparaskopi

Comparison of laparoscopic and open surgical techniques in adrenal masses in terms of outcome

Abstract

Purpose: The aim of this study was to compare the results of conventional and laparoscopic adrenalectomy in adrenal mass cases operated on during a 9-year period.

Materials and Methods: A total of 81 patients who underwent adrenalectomy were included in the study. Patients were divided into two groups as; Group 1 - conventional surgery and Group 2 - laparoscopic surgery. Two groups were compared retrospectively on characteristics such as; age, sex, body mass index (BMI), American Society of Anesthesiologists' score (ASA), mass localization, mass size and hormonal activity of the mass, duration of operation, amount of bleeding in operation, duration of hospitalization, duration until food intake, perioperative mortality, early complications and readmission to hospital within 90 days. 

Results: There were 22 patients in Group 1 and 59 patients in Group 2. No statistically significant difference was found between the groups in terms of age, sex, BMI, ASA score, tumor localization, indications for operation, postoperative complication, perioperative mortality and re-admittance within 90 days. The hormonal activity of the mass was higher and the mass was smaller in size in Group 2. The duration of operation (min), the amount of bleeding in the operation (ml), the duration until oral intake (days) and the length of hospital stay (days) were found to be statistically significantly higher in Group 1.

Conclusion: Laparoscopic adrenalectomy should be the preferred surgical method because of its short duration of operation, low blood loss, early onset of oral food intake and shorter hospital stay, as well as its safety.

Keywords

surrenal, laparascopy

References

• 1-Kaya M, Sürrenal insidentalomada cerrahi tedavinin yeri (Uzmanlık Tezi) ; T.C Sağlık Bakanlığı Haseki Eğitim Ve Araştırma Hastanesi 1.Genel Cerrahi Kliniği 2005.
• 2-Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 1992;327:1033.
• 3-Gill IS. The case for laparoscopic adrenalectomy. J Urol 2001;166:429‐36
• 4- Mercan S, Seven R, Ozarmagan S, Tezelman S. Endoscopic retroperitoneal adrenalectomy. Surgery 1995; 118: 1071-5.
• 5- Bulus H, Uslu HY, Karakoyun R, Koc¸ak S. Comparison of laparoscopic and open adrenalectomy. Acta Chir Belg. 2013;113: 203-7
• 6- Pędziwiatr M, Matłok M, Kulawik J, Major P, Budzyński P, ZubPokrowiecka A, et al. Laparoscopic adrenalectomy by the lateral transperitoneal approach in patients with a history of previous abdominal surgery. Wideochir Inne Tech Maloinwazyjne 2013;8:146–51
• 7- Girgin, M., Çay, F. Our experiences with laparoscopic transperitoneal adrenalectomy. Laparosc Endosc Surg Sci . 2018; 25(1): 1-4
• 8- Lee J, El-Tamer M, Schifftner T, et al. Open and laparoscopic adrenalectomy: analysis of the National Surgical Quality Improvement Program. J Am Coll Surg. 2008;206:953–9;
• 9-Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992;20: 271–274.
• 10-Erdoğan G. Adrenal korteks genel bilgiler ve adrenal korteks hastalıkları. In: Koloğlu S, editor. Endokrinoloji ve temel ve klinik. MN Medical; Ankara 2005. p. 525-60
• 11-İnci O, Aktoz T, Bilir BE, Atakan İH, Tuğrul A. Sürrenal kitlelerinin değerlendirilmesi ve cerrahi yaklaşım: Trakya Üniversitesi deneyimi. Turkish J Urology 2011;37:198-203
• 12-RAMACHANDRAN M. S., REID J. A., DOLAN S. J., FARLING P. A.,RUSSELL C. F. J. Laparoscopic adrenalectomy versus open adrenalectomy : results from a retrospective comparative study. Ulster Med J, 2006; 75 : 126-28.
• 13- Bostancı M, Görgün M, Karaoğlan M, Çatal H. Laparoskopik adrenalektomi sonuçlarının açık adrenalektomi ile kıyaslanması. Ulusal Cerrahi Dergisi. 2009;25:150-6.
• 14-Taffurelli G, Ricci C, Casadei R, et al. Open adrenalectomy in the era of laparoscopic surgery: a review. Updates Surg 2017;69:135-43.
• 15-Carter YM, Mazeh H, Sippel RS et al Safety and feasibility of laparoscopic resection for large (C6 cm) pheochromocytomas without suspected malignancy. Endocr Pract 2012; 18(5):720–726
• 16-BOLLIA M., OERTLIA D., STAUBB J. J., HARDER F. Laparoscopic adrenalectomy : the new standard ? Swiss Med Wkly, 2002; 132 : 12-16.
• 17-Elfenbein, D. M., Scarborough, J. E., Speicher, P. J. & Scheri, R. P.Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J. Surg. Res. 2013;184, 216–220
• 18-Wang HS, Li CC, Chou YH et al.: Comparison of laparoscopic adrenalectomy with open surgery for adrenal tumors. Kaohsiung J Med Sei 2009; 25: 438-44
• 19- Wu CT, Chiang YJ, Chou CC, Liu KL, Lee SH, Chang YH, et al Comparative study of laparoscopic and open adrenalectomy. Chang Gung Med J 2006; 29:468–473
• 20- Balla, A., Ortenzi, M., Palmieri, L., Corallino, D., Meoli, F., Ursi,P et al Laparoscopic bilateral anterior transperitoneal adrenalectomy: 24 years experience. Surgical endoscopy, . 2019;1: 1-7.
• 21- Sgourakis G, Lanitis S, Kouloura A, et al. Laparoscopic versus open adrenalectomy for stage I/II adrenocortical carcinoma: meta-analysis of outcomes. J Invest Surg. 2015;28(3):145–52.
• 22-Mpaili E, Moris D, Tsilimigras DI, Oikonomou D, Pawlik TM, et al. Laparoscopic versus open adrenalectomy for localized/locally advanced primary adrenocortical carcinoma (ENSAT I-III) in adults: is margin-free (R0) resection the key surgical factor that dictates outcome? a review of the literature. J Laparoendosc Adv Surg Tech A. 2018 ;28: 408-414
• 23- Sturgeon C, Shen WT, Clark OH, Duh QY, Kebebew E. Risk assessment in 457 adrenal cortical carcinomas: how much does tumor size predict the likelihood of malignancy? J Am Coll Surg . 2006;202:423–430.24-Sarela AI, Murphy I, Coit DG Metastasis to the adrenal gland: the emerging role of laparoscopic surgery. Ann Surg Oncol 2004; 10:1191–1196
• 25. Janevska V, Janevski V, Stankov O, Spasevska L, Kostadinova-Kunovska S, Zhivadinovik J. Non-Tumor Cystic Lesions of the Adrenal Gland. PRILOZI. 2015;36(3):51–59
• 26. C Sebastiano, X Zhao, FM Deng, K Das Cystic lesions of the adrenal gland: our experience over the last 20 years. Hum Pathol 2013; 44(9):1797–1803
• 27- Tanaka M, Tokuda N, Koga H, et al. Laparoscopic adrenalectomy for pheochromocytoma: Comparison with open adrenalectomy and comparison of laparoscopic surgery for pheochromocytoma versus other adrenal tumors. J Endourol 2000;14:427–431.
• 28- Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw 10, 6; 10.6004/jnccn.2012.0075
• 29 -Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014;99:1915–42.
• 30- Öz B, Akcan A, Emek E, Akyüz M, Sözüer E, Akyıldız H, et al. Laparoscopic surgery in functional and nonfunctional adrenal tumors: A single-center experience. Asian J Surg. 2016;39(3):137- 43.31- Lubikowski J, Kiedrowicz B, Szajko M, Laparoscopic adrenalectomy for functioning and non-functioning adrenal tumours. Endokrynol Pol. 2011;62:512-16
• 32- Pędziwiatr, M., Natkaniec, M., Kisialeuski, M., Major, P., Matłok, M., Kołodziej, D, et al. Adrenal incidentalomas: should we operate on small tumors in the era of laparoscopy? Int J Endocrinol. 2014;2014:658483.
• 33-Chuan-Yu S, Yat-Faat H, Wei-Hong D, et al. Laparoscopicadrenalectomy for adrenal tumors. Int J Endocrinol. 2014; 2014:241-54.
• 34-. Kulis T, Knezevic N, Pekez M, Kastelan D, Grkovic M,Kastelan Z. Laparoscopic adrenalectomy: lessons learned from 306 cases. J Laparoendosc Adv Surg Tech. 2012;22:22-26.
• 35- Hirano D, Hasegawa R, Igarashi T, Satoh K, Mochida J, Takahashi S, et al. Laparoscopic adrenalectomy for adrenal tumors: A 21-year single-institution experience. Asian J Surg. 2015;38(2):79-84.
• 36- Wu, K., Liu, Z., Liang, J., Tang, Y., Zou, Z., Zhou, C et al Laparoscopic versus open adrenalectomy for localized (stage 1/2) adrenocortical carcinoma: experience at a single, high-volumecenter. Surgery 2018; 164:1325–1329
• 37- Haveran, L. A., Novitsky, Y. W., Czerniach, D. R., Kaban, G. K., Kelly, J. J., Litwin, D. E, et al. Benefits of laparoscopic adrenalectomy: a 10-year single institution experience. Surg Laparosc Endosc Percutan Tech 2006; 16: 217-220
• 38- Humphrey R, Gray D, Pautler S, Davies W. Laparoscopic compared with open adrenalectomy for resection of pheochromocytoma: a review of 47 cases. Can J Surg 2008; 51: 276–80
• 39 Fosså, A., Røsok, B. I., Kazaryan, A. M., Holte, H. J., Brennhovd, B., Westerheim, O. , et al, 2013 Laparoscopic versus open surgery in stage I-III adrenocortical carcinoma -- a retrospective comparison of 32 patients. Acta Oncol 52: 1771-1777
• 40-Chotirosnramit N, Angkoolpakdeekul T, Kongdan Y. A laparoscopic versus open adrenalectomy in Ramathibodihospital.J Med Assoc Thai. 2007;90:2638–43
• 41-Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. N Engl J Med. 2013;369:1134-142.
• 42- Beck, A. C., Goffredo, P., Hassan, I., Sugg, S. L., Lal, G., Howe, J. R., et al . Risk factors for 30-day readmission after adrenalectomy. Surgery, 2018 ;164(4): 766-773.