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The Posterior Adiposity Index: A Quantitative Selection Tool for Adrenalectomy Approach.
Brenessa Lindeman1, Atul A Gawande2, Francis D Moore2
1Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
The Journal of Surgical Research
|December 4, 2018
Summary
Imaging can predict optimal adrenalectomy approach. A higher Posterior Adiposity Index (PAI) and larger tumors predict longer operative times for retroperitoneoscopic adrenalectomy, guiding surgical planning.
Area of Science:
- Surgical Oncology
- Radiology
- Minimally Invasive Surgery
Background:
- Adrenalectomy approaches (laparoscopic transabdominal vs. retroperitoneoscopic) lack objective criteria for optimal selection.
- Preoperative imaging characteristics may predict patient suitability for retroperitoneoscopic adrenalectomy.
Purpose of the Study:
- To identify imaging criteria that predict optimal retroperitoneoscopic adrenalectomy.
- To correlate imaging measurements with operative time and blood loss.
Main Methods:
- Retrospective cohort study of 113 patients undergoing minimally invasive adrenalectomy (2014-2016).
- Measured skin-to-Gerota's fascia (S-GF), adrenal-kidney, adrenal-rib, rib-iliac crest distances, and perinephric fat (PNF).
- Developed a Posterior Adiposity Index (PAI) = S-GF + PNF; correlated with operative time and blood loss using regression analysis.
Main Results:
- Larger tumors and higher PAI correlated with longer operative times in retroperitoneoscopic adrenalectomy.
- PAI ≥9 was significantly associated with increased operative time (P=.004).
- No imaging characteristics significantly correlated with estimated blood loss.
Conclusions:
- Preoperative imaging, specifically the PAI, can guide the selection of retroperitoneoscopic adrenalectomy.
- Patients with smaller tumors and PAI <9 are favorable candidates for shorter operative times with retroperitoneoscopic adrenalectomy.
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