Trends in adrenal surgery: institutional review of 528 consecutive adrenalectomies.
OBJECTIVE
The increasing detection of adrenal tumors and the availability of a more sophisticated biochemical work-up leading to rising numbers of sub-clinical Conn's and Cushing's syndromes coincide with a rising number of adrenalectomies worldwide. The aim of our study was to report a single institution's experience with adrenal surgery.


METHODS
We report data of 528 adrenalectomies, operated at our institution before and after the onset of minimally invasive endoscopic surgery (1986-1994, 1995-2008). Gender, age, indication, imaging, surgical approach, operating time, histology, tumor size, hospital stay, and complications were analyzed retrospectively.


RESULTS
A total of 478 patients underwent adrenal surgery during the time observed. The average number of yearly adrenalectomies increased from 14 to 21 (p = 0.001) after the onset of laparoscopic surgery. Imaging techniques showed a significant shift towards magnetic resonance imaging (p < 0.001) and preoperative assessment of tumor size was significantly correlated to malignancy: 10.8 % (11/102) and 42 % (21/50) of tumors measuring 4-6 cm and ≥6 cm, respectively, were malignant in the final histology report (p < 0.001). Patients operated by minimally invasive endoscopy were significantly younger (mean 49.4 years, p = 0.046), had significantly shorter operating times (mean 118 min, p < 0.001), had shorter hospital stays (mean 7.1 days, p < 0.001), and had less complications (6.9 %, p = 0.004) compared to patients resected through open procedures.


CONCLUSIONS
Although adrenalectomy rates increased and minimally invasive endoscopic surgery reduced hospital stay and complications at our institution, the yearly number of procedures was still low with often high surgical complexity. We therefore believe that adrenal surgery remains a highly specialized procedure that should preferably be performed at endocrine surgery centers.
Department of General, Visceral and Pediatric Surgery, University Hospital, Moorenstraße 5, 40225 Düsseldorf, Germany. anja.lachenmayer@med.uni-duesseldorf.de
Anja
A
Lachenmayer
Kenko
K
Cupisti
Achim
A
Wolf
Andreas
A
Raffel
Matthias
M
Schott
Holger S
HS
Willenberg
Claus F
CF
Eisenberger
Wolfram T
WT
Knoefel
D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000311:Adrenal Glands / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D016009:Chi-Square Distribution; D003952:Diagnostic Imaging; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome