Podium 01
經後腹腔鏡腎上腺切除術治療大型腎上腺腫瘤—腫瘤大小與手術負面因子分析: 單一醫學中心回溯性研究
蔡易辰1、謝育哲1,2、曾文歆1、劉建良1,3、何宗翰4、李健逢5、邱文祥6、黃冠華1
台南永康奇美醫院外科部泌尿科1；國立中山大學臨床醫學研究所2；台南永康奇美醫院外科部 泌尿腫瘤科3；台南永康奇美醫院醫學研究部4；台南永康奇美醫院病理部5；台北馬偕醫院泌尿部6
Retroperitoneal laparoscopic adrenalectomy for large adrenal tumors—analysis of tumor size and adverse events: A retrospective single-center study
I-Chen Tsai1、Yu-Che Hsieh 1,2、Wen-Hsin Tseng 1、Chien-Liang Liu1,3、Chung-Han Ho4、Chien-Feng Li5 , Allen W. Chiu6, Steven K. Huang1
1Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;
2 The doctoral Program of Clinical and Experimental Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan;
3 Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;
4 Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
5 Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
6 Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
Background: Adrenal tumors are relatively common, and adrenalectomy is the third most common endocrine surgery. This study aimed to evaluate the frequency of malignancy, oncological outcomes, and perioperative complications in patients with intermediate (4-6 cm, Group 1) and large (>6 cm, Group 2) adrenal tumors undergoing Retroperitoneal Laparoscopic Adrenalectomy (RLA). A key objective was to analyze the impact of tumor size on surgical outcomes.
Materials and Methods: Data from 76 patients who underwent RLA for tumors of size ≥4 cm between 2005 and 2022 at a single tertiary referral center were analyzed retrospectively. Variables included patients’ age, hormone function, operation time, conversion to open approach, perioperative complications, and adverse surgical events (blood loss >500cc, conversion to open approach, and perioperative complications).
Results: No significant differences were observed between the two groups in terms of functional and histopathologic analysis, gender distribution, functioning factors, perioperative complications, and estimated blood loss. However, patients in Group 2 were younger (P=0.04), experienced longer operative times (P=0.005), and had a higher rate of conversion to open surgery (P=0.033). For every 1 cm increase in tumor size, the odds ratio for adverse surgical events increased by 1.58.
Conclusions: RLA is a safe and feasible procedure for adrenal tumors larger than 6 cm. While intraoperative and postoperative complications are not significantly increased in either group, larger tumors increase surgery times and are more likely to require conversion to open surgery. Therefore, caution and preparedness for potential adverse events are recommended when dealing with larger tumors. A tumor size of 5.3 cm may serve as a guide for risk stratification and surgical planning in large adrenal tumor management.