背景:肾上腺切除术通常具有良好的结果。尚不清楚功能性肾上腺肿瘤患者的临床结局是否与良性肾上腺肿瘤患者不同。由于存在继发于功能性肿瘤的合并症。我们调查了良性非功能性(BNF)和功能性肾上腺肿块的开放和腹腔镜肾上腺切除术后的结果。
方法:在2015-2020年国家手术质量改进计划数据库中确定了接受肾上腺切除术的患者,然后归类为BNF,醛固酮增多症,皮质醇增多症,和嗜铬细胞瘤.感兴趣的主要结局是30d发病率,次要结局包括30d死亡率,30天重新接纳,术后住院时间(LOS)。根据手术方法进行亚组分析。进行了单变量分析,然后对BNF患者和功能性肿瘤患者的个体结局进行多变量逻辑回归分析,单因素分析具有统计学意义的患者人口统计学和手术方法。描述性统计和结果分析采用Pearsonχ2检验和Mann-WhitneyU检验。
结果:有3291例BNF患者,484例醛固酮增多症,263皮质醇增多症,和46个嗜铬细胞瘤.腹腔镜组中3615例(88.5%)肾上腺切除术患者,与BNF患者相比,醛固酮增多症患者术后发病率较低(1.9%对5.2%,P<0.001)和较短的LOS(1d,四分位数间距(IQR)[1-1]与1dIQR[1-2],P=0.003);这些数据在多变量分析中仍然存在(OR0.32,95%置信区间[CI]0.14-0.74和比值比0.47,95%CI0.36-0.60,P<0.001)。皮质醇增多症患者的发病率较高(7.3%对5.2%,P<0.001),30天再入院率(5.3%对2.9%,P=0.042)和较长的LOS(2d,IQR[1-3]对1d,IQR[1-2,P<0.001)。在多变量分析中,皮质醇增多症的存在与30d内再入院的可能性增加(OR2.20,95%CI1.11-2.99,P=0.012)和LOS延长(>1d)独立相关(OR1.79,95%CI1.33-2.40,P<0.001).与BNF患者相比,嗜铬细胞瘤患者术后发病率较高(6.2%对5.2%,P<0.001)。开放组469例(11.5%的肾上腺切除术患者),BNF患者和功能性肾上腺肿块患者的结局无统计学差异.
结论:功能性肿瘤肾上腺切除术后的结果因手术指征而异。
BACKGROUND: Adrenalectomy generally has favorable outcomes. It is unknown if patients with functional adrenal tumors experience different clinical outcomes than those with benign adrenal tumors, due to the presence of comorbid conditions secondary to the functional tumor. We investigated outcomes following open and laparoscopic adrenalectomy for benign nonfunctional (BNF) versus functional adrenal masses.
METHODS: Patients undergoing adrenalectomy were identified in the 2015-2020 National Surgical Quality Improvement Program database, then categorized as BNF, hyperaldosteronism, hypercortisolism, and pheochromocytoma. The primary outcome of interest was 30-d morbidity and secondary outcomes included 30-d mortality, 30-d readmission, and postoperative length of stay (LOS). Subgroup analysis was performed based upon surgical approach. Univariate analysis was performed, followed by multivariable logistic regression for individual outcomes that differed significantly between patients with BNF and functional neoplasm, factoring in patient demographics and operative approach with statistical significance on univariate analysis. Descriptive statistics and outcomes were analyzed using Pearson\'s χ2 test and Mann-Whitney U-test as appropriate.
RESULTS: There were 3291 patients with BNF while 484 had hyperaldosteronism, 263 hypercortisolism, and 46 pheochromocytomas. Within the laparoscopic group of 3615 (88.5%) of adrenalectomy patients, compared to BNF patients, patients with hyperaldosteronism had lower rates of postoperative morbidity (1.9% versus 5.2%, P < 0.001) and shorter LOS (1 d, interquartile range (IQR) [1-1] versus 1d IQR [1-2], P = 0.003); these persisted on multivariate analysis (OR 0.32, 95% confidence interval [CI] 0.14-0.74 and odds ratio 0.47, 95% CI 0.36-0.60, P < 0.001). Patients with hypercortisolism had higher morbidity (7.3% versus 5.2%, P < 0.001), 30-d readmission rates (5.3% versus 2.9%, P = 0.042) and longer LOS (2d, IQR [1-3] versus 1d, IQR [1-2, P < 0.001). On multivariate analysis, presence of hypercortisolism was independently associated with increased likelihood of readmission within 30 d (OR 2.20, 95% CI 1.11-2.99, P = 0.012) and longer LOS (>1 d) (OR 1.79, 95% CI 1.33-2.40, P < 0.001). Compared to BNF patients, patients with pheochromocytoma had higher rates of postoperative morbidity (6.2% versus 5.2%, P < 0.001). Within the open group of 469 (11.5% of adrenalectomy patients), there were no statistically significant differences in outcomes between patients with BNF and functional adrenal masses.
CONCLUSIONS: Outcomes after adrenalectomy performed for functional neoplasms differ based on surgical indication.