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Redefining surgical boundaries: outcomes of minimally invasive adrenalectomy in large pheochromocytomas
Qinghua Gan1,2,3,4, Yi Huang1,3,4, Huarun Li1,3,4
1Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P. R. China.
Background:
The safety and efficacy of minimally invasive adrenalectomy (MIA) for large pheochromocytoma (PHEO) remains a hotly debated topic. This study aims to shed light on the feasibility and safety of MIA for PHEOs > 5 cm.
Materials And Methods:
We conducted a comprehensive retrospective analysis of 135 patients who underwent MIA for PHEOs at our centre from January 2016 to February 2023. After propensity score-matching (PSM) to balance baseline variables, 91 patients with tumours ≤ 5 cm and 44 patients with tumours > 5 cm were grouped into 33 pairs. Patient demographics and perioperative data were meticulously recorded and compared.
Results:
After PSM, 33 pairs of patients were included (the larger group: 13 males, 20 females; mean age 50.0 ± 14.8 years; the smaller group: 12 males, 21 females; mean age 53.7 ± 11.8 years). There was no significant difference in baseline characteristics between the two groups except for tumour size (6.4 vs. 3.4 cm, p < 0.001). The larger group had longer operative time (130 vs. 95 min, p = 0.020) and drainage tube removal time (4.0 vs. 3.0 days, p = 0.005). However, no significant differences were observed in intraoperative hemodynamic outcomes, transfusion rate and perioperative complications. Logistic regression analysis revealed that hypertension was an independent risk factor for hemodynamic instability (OR = 6.681, 95% CI: 1.270-35.148, p = 0.025).
Conclusions:
Although MIA for PHEOs > 5 cm had longer operative time and drainage tube removal time, it did not affect intraoperative hemodynamic outcomes and perioperative complications. Thus, minimally invasive adrenalectomy represents a viable and effective surgical option for managing large PHEO.
Insights
Minimally invasive adrenalectomy (MIA) is safe and effective for large pheochromocytomas (> 5 cm). While operative time and drainage tube removal may be longer, MIA does not increase complications or affect hemodynamic stability, making it a viable option.
Area of Science:
- Endocrinology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- The use of minimally invasive adrenalectomy (MIA) for large pheochromocytomas (PHEO) is a subject of ongoing debate.
- Assessing the safety and feasibility of MIA for PHEOs exceeding 5 cm is crucial for surgical management.
Purpose of the Study:
- To evaluate the safety and efficacy of MIA in patients with PHEOs larger than 5 cm.
- To compare perioperative outcomes between patients with PHEOs > 5 cm and those with smaller tumors.
Main Methods:
- A retrospective analysis of 135 patients who underwent MIA for PHEO between January 2016 and February 2023.
- Propensity score-matching (PSM) was used to create comparable groups of patients with tumors ≤ 5 cm and > 5 cm.
- Demographic and perioperative data were collected and analyzed.
Main Results:
- After PSM, 33 pairs of patients were analyzed. The group with larger tumors (> 5 cm) exhibited longer operative times (130 vs. 95 min) and drainage tube removal times (4.0 vs. 3.0 days).
- No significant differences were found in intraoperative hemodynamic outcomes, transfusion rates, or perioperative complications between the groups.
- Hypertension was identified as an independent risk factor for hemodynamic instability (OR = 6.681, p = 0.025).
Conclusions:
- Minimally invasive adrenalectomy is a safe and effective surgical approach for managing large pheochromocytomas (> 5 cm).
- Despite potentially longer operative and recovery times, MIA does not compromise hemodynamic stability or increase complication rates for larger tumors.
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