Laparoscopic adrenalectomy: pathologic features determine outcome.
BACKGROUND
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).


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Centre for Minimally Invasive Surgery, St. Michael's Hospital, Toronto, Ont. EPoulin@ottawahospital.on.ca
Eric C
EC
Poulin
Christopher M
CM
Schlachta
Stephen E
SE
Burpee
Kenneth T
KT
Pace
Joseph
J
Mamazza
D000236:Adenoma / Q000601:surgery*; D000306:Adrenal Cortex Neoplasms / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001835:Body Weight; D003480:Cushing Syndrome / Q000601:surgery*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000601:surgery*; D018579:Patient Selection; D010673:Pheochromocytoma / Q000601:surgery*; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome