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Volume-outcome correlation in adrenal surgery-an ESES consensus statement.

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High-volume centers performing at least 6 adrenal operations annually improve patient outcomes. Adrenocortical cancer surgery requires centers with 12+ annual cases, emphasizing multidisciplinary teams and prospective data recording.

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Area of Science:

  • Endocrine Surgery
  • Surgical Outcomes
  • Adrenal Operations

Background:

  • Most adrenal operations are performed by low-volume surgeons (1 case/year).
  • High-volume surgeons are defined as performing ≥4 adrenal operations annually.
  • Significant variation exists in annual adrenal operation numbers across countries.

Framework:

  • Consensus statement developed by the European Society of Endocrine Surgeons (ESES) working group.
  • Findings discussed and agreed upon at the ESES-2019 conference.
  • Recommendations based on a review of published literature.

Implementation:

  • Laparoscopic, retroperitoneoscopic, and robotic adrenalectomy learning curves range from 20-40 cases.
  • High-volume centers demonstrate more favorable preoperative morbidity and shorter hospital stays.
  • Establishment of integrated multidisciplinary teams is recommended for all centers.

Implications:

  • Adrenal surgery should be centralized in high-volume centers (≥6 cases/year).
  • Adrenocortical cancer surgery should be restricted to specialized centers (≥12 cases/year).
  • Prospective clinical data recording and contribution to EUROCRINE and ENSAT databases are strongly encouraged for continuous improvement.