Erschienen in:
01.09.2010 | Endocrine Surgery
Results of adrenal surgery. Data of a Spanish National Survey
verfasst von:
Jesús María Villar, Pablo Moreno, Joaquín Ortega, Elisabeth Bollo, César Pablo Ramírez, Nuria Muñoz, Cristina Martínez, Eduardo Domínguez-Adame, Juan Sancho, José Miguel del Pino, José Manuel Couselo, Ana Carrión, Marifé Candel, Nieves Cáceres, José María Octavio, Francisco Mateo, Lourdes Galán, José Manuel Ramia, Javier Aguiló, Francisco Herrera
Erschienen in:
Langenbeck's Archives of Surgery
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Ausgabe 7/2010
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Abstract
Purpose
Given the availability of laparoscopy and the rising detection of incidentalomas, indications for adrenalectomy may be changing. The Endocrine Surgery Section of the Spanish Association of Surgeons designed a survey to assess its indications, techniques, and results in Spanish Surgical Departments.
Methods
Collected data included hospital and department type, yearly hospital volume of procedures; location studies and preoperative preparation performed, indications, surgical approach and instruments used, and results in terms of morbidity and overall hospital stay. The analysis included a comparison between results of high- or low-volume centers and surgeons, using the Student's t test for quantitative and chi-square test for qualitative variables. Level of significance was set at 0.05.
Results
Nineteen centers returned the questionnaire, including 155 adrenalectomies performed in 2008. Most frequent indications were pheochromocytoma (23.2%), aldosteronoma (16.7%), incidentaloma (12.2%), metastasis (10.3%), Cushing adenoma (9.6%), and carcinoma (3.8%). Laparoscopy was performed in 83.9% of cases (9.4% required conversion to laparotomy). Four patients required urgent reoperation. Average hospital stay: 4.6 days (3.3 days after laparoscopy, 7 days after laparotomy). High-volume centers had a greater proportion of laparoscopically treated cases (p = 0.008), more malignant lesions treated (p = 0.03), a shorter overall stay (p < 0.0001), and a shorter stay after laparotomic adrenalectomy (p = 0.01). High-volume surgeons had similar results, and less in-hospital morbidity (p = 0.02).
Conclusions
In Spain, adrenalectomy is performed in hospitals of varying complexity. Laparoscopic approach is the rule, with good results in terms of morbidty and stay. High-volume centers and surgeons had best results in terms of use of minimally invasive surgery and hospital stay.