Purpose
To identify presurgical and surgical risk factors for postsurgical complications in the pheochromocytoma surgery.
Methods
A retrospective study of pheochromocytomas submitted to surgery in ...ten Spanish hospitals between 2011 and 2021. Postoperative complications were classified according to Clavien-Dindo scale.
Results
One hundred and sixty-two surgeries (159 patients) were included. Preoperative antihypertensive blockade was performed in 95.1% of the patients, being doxazosin in monotherapy (43.8%) the most frequent regimen. Patients pre-treated with doxazosin required intraoperative hypotensive treatment more frequently (49.4% vs 25.0%,
P
= 0.003) than patients treated with phenoxybenzamine, but no differences in the rate of intraoperative and postsurgical complications were observed. However, patients treated with phenoxybenzamine had a longer hospital stay (12.2 ± 11.16 vs 6.2 ± 6.82,
P
< 0.001) than those treated with doxazosin. Hypertension resolution was observed in 78.7% and biochemical cure in 96.6% of the patients. Thirty-one patients (19.1%) had postsurgical complications. Prolonged hypotension was the most common, in 9.9% (
n
= 16), followed by hypoglycaemia in six patients and acute renal failure in four patients. 13.0% of complications had a score ≥3 in the Clavien-Dindo scale. Postsurgical complications were more common in patients with diabetes, cerebrovascular disease, higher plasma glucose levels, higher urinary free metanephrine and norepinephrine, and with pheochromocytomas larger than 5 cm.
Conclusion
Preoperative medical treatment and postsurgical monitoring of pheochromocytoma should be especially careful in patients with diabetes, cerebrovascular disease, higher levels of plasma glucose and urine free metanephrine and norepinephrine, and with pheochromocytomas >5 cm, due to the higher risk of postsurgical complications.
Background
Early laparoscopic cholecystectomy (ELC) is the gold standard treatment for patients with acute calculous cholecystitis (ACC); however, it is still related to significant postoperative ...complications. The aim of this study is to identify factors associated with an increased risk of postoperative complications and develop a preoperative score able to predict them.
Methods
Multicentric retrospective analysis of 1868 patients with ACC submitted to ELC. Included patients were divided into two groups according to the presentation of increased postoperative complications defined as postoperative complications ≥ Clavien-Dindo IIIa, length of stay greater than 10 days and readmissions within 30 days of discharge. Variables that were independently predictive of increased postoperative complications were combined determining the Chole-Risk Score, which was validated through a correlation analysis.
Results
We included 282 (15.1%) patients with postoperative complications. The multivariate analysis predictors of increased morbidity were previous percutaneous cholecystostomy (OR 2.95,
p
=0.001), previous abdominal surgery (OR 1.57,
p
=0.031) and diabetes (OR 1.62,
p
=0.005); Charlson Comorbidity Index >6 (OR 2.48,
p
=0.003), increased total bilirubin > 2 mg/dL (OR 1.88,
p
=0.002), dilated bile duct (OR 1.79,
p
=0.027), perforated gallbladder (OR 2.62,
p
<0.001) and severity grade (OR 1.93,
p
=0.001).
The Chole-Risk Score was generated by grouping these variables into four categories, with scores ranging from 0 to 4. It presented a progressive increase in postoperative complications ranging from 5.8% of patients scoring 0 to 47.8% of patients scoring 4 (
p
<0.001).
Conclusion
The Chole-Risk Score represents an intuitive tool capable of predicting postoperative complications in patients with ACC.
To analyze surgical outcomes and predictive factors for long-term overall and disease-specific survival in patients undergoing surgical resection of adrenal metastasis.
A multicenter retrospective ...study included patients who underwent adrenalectomy for adrenal metastasis in two Spanish hospitals between 2005 and 2021. Clinical variables associated with surgical complications and survival during follow-up were analyzed.
Thirty-three patients were included. Adrenalectomy was performed laparoscopically in 27 patients and by an open approach in 6. The most common primary tumor site was the lung (n=15), followed by the kidney (n=7). Most patients had metachronous lesions (n=28). Six patients (18.2%) had intra- and/or postoperative complications; synchronous metastasis was a risk factor (odds ratio 12.5 1.45–107.6) for their development. Progression-free survival and disease-specific survival were 7.5months (range 1–64) and 22.5months (6–120), respectively. Survival rates at 1, 2, 3 and 5years were 94%, 65%, 48% and 29%, respectively. Survival was significantly lower in patients with lung cancer than with other cancers (hazard ratio 4.23 1.42–12.59).
Adrenalectomy for solitary adrenal metastases was associated with intra- or postoperative complications in 18% of cases. Synchronous metastasis was a risk factor for complications.
To evaluate the impact of obesity and overweight on surgical outcomes in a large cohort of patients who underwent adrenalectomy due to benign or malignant primary adrenal disease.
A retrospective ...single-center study of patients without history of active extraadrenal malignancy, with adrenal tumors operated on consecutively in our center between January 2010 and December 2022. Obesity was defined as a body mass index (BMI)≥30kg/m2 and overweight as BMI between 25.0 and 30.0kg/m2.
Of 146 patients with adrenal tumors who underwent adrenalectomy, 9.6% (n=14) were obese, 54.8% (n=80) overweight and 35.6% (n=52) normal weight. Obese patients had higher diastolic blood pressure (87.6±12.22 vs. 79.3±10.23mmHg, P=0.010) and a higher prevalence of dyslipidemia (57.1% vs. 25.8%, P=0.014) and bilateral tumors (14.3% vs. 3.1%, P=0.044) than non-obese patients. The rates of intraoperative and of postsurgical complications were similar between obese/overweight patients and patients with normal weight. However, a significantly higher rate of postsurgical complications (27.3% vs. 5.7%, P=0.009) and a longer hospital stay (5.4±1.39 vs. 3.5±1.78 days, P=0.007) were observed in patients with obesity than in non-obese patients. In the multivariant analysis, obesity, age, ASA>2 and tumor size were independent risk factors for postoperative complications, with obesity being the most important factor (OR 23.34 2.23–244.24).
Obesity and overweight are common conditions in patients who undergo adrenalectomy. Adrenalectomy is considered a safe procedure in patients with overweight, but it is associated with a higher risk of postsurgical complications and longer hospital stay in obese patients.
Evaluar el impacto de la obesidad y el sobrepeso en los resultados quirúrgicos en una cohorte de pacientes que se sometieron a adrenalectomía debido a enfermedad suprarrenal primaria benigna o maligna.
Estudio unicéntrico retrospectivo de pacientes sin antecedentes de neoplasia maligna extraadrenal activa con tumores suprarrenales operados de forma consecutiva en nuestro centro durante enero de 2010 y diciembre de 2022. Se definió obesidad como un índice de masa corporal (IMC) ≥30kg/m2 y sobrepeso como un IMC entre 25,0 y 30,0kg/m2.
De 146 pacientes con tumores suprarrenales a los que se les realizó adrenalectomía, el 9,6% (n=14) presentaba obesidad, el 54,8% (n=80) sobrepeso y el 35,6% (n=52) normopeso. Los pacientes obesos tenían cifras más altas de tensión arterial diastólica (87,6±12,22 vs. 79,3±10,23mmHg; p=0,010) y una mayor prevalencia de dislipemia (57,1 vs. 25,8%; p=0,014) y de tumores bilaterales (14,3 vs. 3,1%; p=0,044) que los pacientes no obesos. La tasa de complicaciones intraoperatorias y posquirúrgicas fue similar entre pacientes obesos/con sobrepeso y pacientes con normopeso. Sin embargo, se observó una tasa significativamente mayor de complicaciones posquirúrgicas (27,3 vs. 5,7%; p=0,009) y una estancia hospitalaria más prolongada (5,4±1,39 vs. 3,5±1,78 días; p=0,007) en pacientes con obesidad que en los no obesos. En el análisis multivariante, la obesidad, la edad, un ASA>2 y el tamaño tumoral fueron factores de riesgo independientes de complicaciones postoperatorias, siendo la obesidad el factor más importante (OR: 23,34 2,23-244,24).
La obesidad y el sobrepeso son condiciones frecuentes en los pacientes que se someten a adrenalectomía. La suprarrenalectomía se considera un procedimiento seguro en los pacientes con sobrepeso, pero se asocia con un mayor riesgo de complicaciones posquirúrgicas y a una mayor estancia hospitalaria en los pacientes obesos.
To analyze surgical outcomes and predictive factors for long-term overall and disease-specific survival in patients undergoing surgical resection of adrenal metastasis.
A multicenter retrospective ...study included patients who underwent adrenalectomy for adrenal metastasis in two Spanish hospitals between 2005 and 2021. Clinical variables associated with surgical complications and survival during follow-up were analyzed.
Thirty-three patients were included. Adrenalectomy was performed laparoscopically in 27 patients and by an open approach in 6. The most common primary tumor site was the lung (n=15), followed by the kidney (n=7). Most patients had metachronous lesions (n=28). Six patients (18.2%) had intra- and/or postoperative complications; synchronous metastasis was a risk factor (odds ratio 12.5 1.45-107.6) for their development. Progression-free survival and disease-specific survival were 7.5months (range 1-64) and 22.5months (6-120), respectively. Survival rates at 1, 2, 3 and 5years were 94%, 65%, 48% and 29%, respectively. Survival was significantly lower in patients with lung cancer than with other cancers (hazard ratio 4.23 1.42-12.59).
Adrenalectomy for solitary adrenal metastases was associated with intra- or postoperative complications in 18% of cases. Synchronous metastasis was a risk factor for complications.
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