Objective:Clinical practice guidelines recommend open adrenalectomy(OA)for large pheochromocytoma(LPCC)>6 cm in size.Although laparoscopic adrenalectomy(LA)for the treatment of LPCC has been reported,its role remai...Objective:Clinical practice guidelines recommend open adrenalectomy(OA)for large pheochromocytoma(LPCC)>6 cm in size.Although laparoscopic adrenalectomy(LA)for the treatment of LPCC has been reported,its role remains unclear.This study aimed to compare the effectiveness of LA and OA,and summary the surgical treatment experience.Methods:Data concerning LPCC,from January 2010 to June 2019 of a single institution,were retrospectively reviewed.Altogether 82 patients with a tumor larger than 6 cm were included(52 patients in LA group and 30 patients in OA group).Groups were balanced by propensity score matching(PSM)into 15 pairs.Patients’demographics,preoperative characteristics,and prognosis were analyzed.Results:Before PSM,the OA group had larger tumor sizes(median[interquartile range,IQR]:8.9[7.3-10.3]vs.7.2[6.7-8.0]cm;p=0.000)and higher vanillylmandelic acid level(median[IQR]:114.3[67.8-326.4]vs.66.6[37.8-145.8]μmol/24 h;p=0.004)and needed a higher cumulative dose of prazosin(median[IQR]:83.5[37.0-154.0]vs.38.0[21.0-81.0]mg;p=0.028).After PSM,the baseline data showed no significant differences between both groups.The LA group had relatively more stable blood pressure in surgery,with a lower fluctuation of systolic blood pressure(mean±standard deviation[SD]:70.9±25.1 vs.107.4±46.2 mmHg,p=0.012)and a lower percentage of hemodynamic instability(46.7%vs.86.7%,p=0.020).The LA group had shorter postoperative hospital stays(mean±SD:6.4±2.7 vs.10.1±3.4 days;p=0.003)than the OA group.Differences regarding metastasis rate(6.7%vs.0,p=1.000)were not statistically significant between LA and OA groups.The median(IQR)follow-up time of 82 patients was 72.5(47.0-103.5)months.Binary logistic regression showed that right-side tumors or those>8 cm in size were independent risk factors of OA.Conclusion:LA is a safe,minimally invasive procedure for LPCC and has relatively better perioperative characteristics in large medical centers.Patients with tumors on the right side or larger than 8 cm are more likely to undergo OA initially.展开更多
文摘Objective:Clinical practice guidelines recommend open adrenalectomy(OA)for large pheochromocytoma(LPCC)>6 cm in size.Although laparoscopic adrenalectomy(LA)for the treatment of LPCC has been reported,its role remains unclear.This study aimed to compare the effectiveness of LA and OA,and summary the surgical treatment experience.Methods:Data concerning LPCC,from January 2010 to June 2019 of a single institution,were retrospectively reviewed.Altogether 82 patients with a tumor larger than 6 cm were included(52 patients in LA group and 30 patients in OA group).Groups were balanced by propensity score matching(PSM)into 15 pairs.Patients’demographics,preoperative characteristics,and prognosis were analyzed.Results:Before PSM,the OA group had larger tumor sizes(median[interquartile range,IQR]:8.9[7.3-10.3]vs.7.2[6.7-8.0]cm;p=0.000)and higher vanillylmandelic acid level(median[IQR]:114.3[67.8-326.4]vs.66.6[37.8-145.8]μmol/24 h;p=0.004)and needed a higher cumulative dose of prazosin(median[IQR]:83.5[37.0-154.0]vs.38.0[21.0-81.0]mg;p=0.028).After PSM,the baseline data showed no significant differences between both groups.The LA group had relatively more stable blood pressure in surgery,with a lower fluctuation of systolic blood pressure(mean±standard deviation[SD]:70.9±25.1 vs.107.4±46.2 mmHg,p=0.012)and a lower percentage of hemodynamic instability(46.7%vs.86.7%,p=0.020).The LA group had shorter postoperative hospital stays(mean±SD:6.4±2.7 vs.10.1±3.4 days;p=0.003)than the OA group.Differences regarding metastasis rate(6.7%vs.0,p=1.000)were not statistically significant between LA and OA groups.The median(IQR)follow-up time of 82 patients was 72.5(47.0-103.5)months.Binary logistic regression showed that right-side tumors or those>8 cm in size were independent risk factors of OA.Conclusion:LA is a safe,minimally invasive procedure for LPCC and has relatively better perioperative characteristics in large medical centers.Patients with tumors on the right side or larger than 8 cm are more likely to undergo OA initially.
