Results of adrenal surgery. Data of a Spanish National Survey.
OBJECTIVE
Given the availability of laparoscopy and the rising detection of incidentalomas, indications for adrenalectomy may be changing. The Endocrine Surgery Section of the Spanish Association of Surgeons designed a survey to assess its indications, techniques, and results in Spanish Surgical Departments.


METHODS
Collected data included hospital and department type, yearly hospital volume of procedures; location studies and preoperative preparation performed, indications, surgical approach and instruments used, and results in terms of morbidity and overall hospital stay. The analysis included a comparison between results of high- or low-volume centers and surgeons, using the Student's t test for quantitative and chi-square test for qualitative variables. Level of significance was set at 0.05.


RESULTS
Nineteen centers returned the questionnaire, including 155 adrenalectomies performed in 2008. Most frequent indications were pheochromocytoma (23.2%), aldosteronoma (16.7%), incidentaloma (12.2%), metastasis (10.3%), Cushing adenoma (9.6%), and carcinoma (3.8%). Laparoscopy was performed in 83.9% of cases (9.4% required conversion to laparotomy). Four patients required urgent reoperation. Average hospital stay: 4.6 days (3.3 days after laparoscopy, 7 days after laparotomy). High-volume centers had a greater proportion of laparoscopically treated cases (p = 0.008), more malignant lesions treated (p = 0.03), a shorter overall stay (p < 0.0001), and a shorter stay after laparotomic adrenalectomy (p = 0.01). High-volume surgeons had similar results, and less in-hospital morbidity (p = 0.02).


CONCLUSIONS
In Spain, adrenalectomy is performed in hospitals of varying complexity. Laparoscopic approach is the rule, with good results in terms of morbidity and stay. High-volume centers and surgeons had best results in terms of use of minimally invasive surgery and hospital stay.
Villar
Jesús María
JM
Surgical Department, Virgen de Nieves Universitary Hospital, C/Hoya de Mora, 9, 2° A, 18008 Granada, Spain. jevillarmo@yahoo.es
Moreno
Pablo
P
Ortega
Joaquín
J
Bollo
Elisabeth
E
Ramírez
César Pablo
CP
Muñoz
Nuria
N
Martínez
Cristina
C
Domínguez-Adame
Eduardo
E
Sancho
Juan
J
del Pino
José Miguel
JM
Couselo
José Manuel
JM
Carrión
Ana
A
Candel
Marifé
M
Cáceres
Nieves
N
Octavio
José María
JM
Mateo
Francisco
F
Galán
Lourdes
L
Ramia
José Manuel
JM
Aguiló
Javier
J
Herrera
Francisco
F
D000307:Adrenal Gland Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D018246:Adrenocortical Adenoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D010673:Pheochromocytoma / Q000175:diagnosis / Q000601:surgery; D011159:Population Surveillance; D011183:Postoperative Complications / Q000453:epidemiology; D018570:Risk Assessment; D013030:Spain; D011795:Surveys and Questionnaires