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Laparoscopic Adrenalectomy More Beneficial Than Open Adrenalectomy -- Even For Functional Adenomas: Presented at SSO

By Mary Beth Nierengarten

CHICAGO -- March 18, 2008 -- Laparoscopic adrenalectomy (LA) should be the treatment of choice for most benign adrenal tumours, including functional tumours, according to comprehensive research demonstrating improved benefits over open adrenalectomy (OA). The Yale University study was presented March 14 here at the 61st Annual Cancer Symposium of the Society of Surgical Oncology (SSO 2008).

"Consistent with previous studies, the laparoscopic approach results in [a decreased] hospital stay, less blood loss, and lower complication rates than the open approach," said lead author Paul C. Tang, MD, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut. "This is true for tumours overall, as well as [for] certain tumour subgroups."

Although the improved benefits of LA over OA have already been seen in other published data, which has established LA as the current standard of care for benign disease, this study also evaluated outcomes based on tumour subtypes.

Dr. Tang and colleagues retrospectively evaluated the outcomes of 209 consecutive patients who underwent LA (n = 131) or OA (n = 78) at their institution from 1985 to 2006. Outcomes included length of hospital stay, surgical intensive-care-unit stay, estimated blood loss, and complications.

Compared with OS, LA was associated with a significant decrease in the length of hospital stay (9.1 vs 2.8 days, P < .0001), surgical intensive-care-unit stay (1.7 vs 0.8 days, P < .0001), complications (0.44 vs 0.21 per admission, P = .018), and estimated blood loss (814 vs 110 ml, P < .001).

Both length of stay and estimated blood loss were significantly decreased in the subgroup analysis comparing LA with OA across all four adrenal-tumour types (pheochromocytoma, aldosteronomas, cortisol-secreting adenoma, and nonfunctional adenoma).

Comparison of LA outcomes by tumour type, however, demonstrated that patients with pheochromocytomas had significantly longer surgical intensive-care-unit stays compared with patients with nonfunctional adenomas (3.1 vs 0.5 days, P < .05), aldosteronomas (3.1 vs 0.3 days, P < .05), and cortisol-secreting adenomas (3.1 vs 0.2 days, P < .05).

Pheochromocytomas also were associated with a greater length of stay compared with aldosteronomas (2.7 vs 2.1 days, P < .05). Furthermore, pheochromocytomas were associated with higher estimated blood loss than were aldosteronomas (130 vs 53 ml, P < .05) or cortisol-secreting tumours (130 vs 67 ml, P < .05).

Based on the poorer outcomes for patients with pheochromocytoma tumours, Dr. Tang noted that more experienced surgeons should be managing difficult-to-treat tumour subtypes such as pheochromocytoma.

[Presentation title: An Outcomes Analysis of Laparoscopic Versus Open Adrenalectomy. Abstract P45]

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