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Risk factors for open conversion of lateral transperitoneal laparoscopic adrenalectomy: retrospective cohort study of the Spanish Adrenal Surgery Group (SASG)

  • 2019 EAES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic adrenalectomy has become the standard of care for treating adrenal tumors. Conversion from laparoscopic adrenalectomy to an open approach during surgery may be necessary in some cases. This study aimed to identify the risk factors for open conversion of laparoscopic adrenalectomy.

Methods

Retrospective analysis of all consecutive patients undergoing lateral transperitoneal laparoscopic adrenalectomy in six endocrine surgery units of the Spanish Adrenal Surgery Group (SASG) between January 2005 and December 2017. Demographic, clinical, surgical, and histopathologic characteristics were recorded. Risk factors for conversion were assessed by logistic regression analysis.

Results

Of a total of 865 patients included in the study, 58 (6.7%) required conversion to open surgery. In the univariate analysis, factors associated with conversion from laparoscopic to open adrenalectomy were body mass index (BMI) ≥ 30 kg/m2 (P = 0.002), previous abdominal surgery (P = 0.015), tumor size > 5 cm (P = 0.001), and surgery for pheochromocytoma (P = 0.034). In the multivariate analysis, independent risk factors were BMI ≥ 30 kg/m2 [odds ratio (OR) 4.26, 95% confidence interval (CI) 2.81–8.75; P = 0.001], tumor size > 5 cm (OR 10.15, 95% CI 4.24–28.31; P < 0.001), and surgery for pheochromocytoma (OR 2.96, 95% CI 1.89–11.55; P = 0.015).

Conclusions

Obesity, tumor size, and pheochromocytoma as the type of adrenal tumor were predictive factors for intraoperative conversion from laparoscopic to open adrenalectomy. Preoperative assessment of these characteristics should be valuable to clinicians in discussing conversion risk in patients and for surgical planning.

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Acknowledgements

We thank Marta Pulido, MD, for editing the manuscript and editorial assistance.

Funding

No direct or indirect financial support by extramural sources was received.

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Authors and Affiliations

  1. Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain

    Oscar Vidal, David Saavedra-Perez, Mauro Valentini & Laureano Fernandez-Cruz

  2. Department of Surgery, Hospital Universitario Virgen del Rocío, Seville, Spain

    Juan Manuel Martos

  3. Unit of Endocrine Surgery, Department of General and Digestive Surgery, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain

    Aitor de la Quintana

  4. Unit of Endocrine Surgery, Hospital Universitari Josep Trueta, Gerona, Spain

    Jose Ignacio Rodriguez

  5. Unit of Endocrine Surgery, Department of General Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain

    Jesus Villar

  6. Department of Surgery, Hospital Clínico Universitario, University of Valencia, Valencia, Spain

    Joaquin Ortega

  7. Department of Surgery, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain

    Antonio Moral

  8. Department of Surgery, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain

    Manuel Duran

  9. Department of Endocrine Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain

    David Saavedra-Perez

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  1. Oscar Vidal
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  11. Laureano Fernandez-Cruz
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Corresponding author

Correspondence to David Saavedra-Perez.

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Disclosures

Drs. Vidal, Saavedra-Perez, Martos, de la Quintana, Rodriguez, Villar, Ortega, Moral, Duran, Valentini, and Fernandez-Cruz have no conflicts of interest or financial ties to disclose.

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Vidal, O., Saavedra-Perez, D., Martos, J.M. et al. Risk factors for open conversion of lateral transperitoneal laparoscopic adrenalectomy: retrospective cohort study of the Spanish Adrenal Surgery Group (SASG). Surg Endosc 34, 3690–3695 (2020). https://doi.org/10.1007/s00464-019-07264-1

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