Expectations and Outcomes When Moving from Open to Laparoscopic Adrenalectomy: Multivariate Analysis |
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Authors: | Barreca Marco Presenti Luigi Renzi Cristina Cavallaro Giuseppe Borrelli Andrea Stipa Francesco Valeri Andrea |
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Institution: | (1) 1st Department of Surgery “Pietro Valdoni”, Universitá “La Sapienza”, Via Lancisi, 2-00161, Rome, Italy,;(2) Department of General and Vascular Surgery, Azienda Ospedale di Careggi, Viale Pieraccini, 17-50139, Florence, Italy,;(3) Health Care Quality Research Unit, Istituto Dermopatico dell’Immacolata (IDI-IRCCS), Via dei Monti di Creta, 104-00617, Rome, Italy, |
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Abstract: | Abstract
Various authors have suggested that laparoscopic adrenalectomy (LA) leads to better surgical outcomes than open surgery. The
debate is still open, however, and indications and limitations of minimally invasive surgery have not been completely established.
The objective of our study was to compare surgical outcomes of LA and open adrenalectomy (OA), using multivariate analysis
to adjust for potential confounding factors (e.g., size of the lesion, histology). Between 1995 and June 2000 at “Careggi”
Hospital in Florence, Italy patients with an indication for adrenalectomy were treated laparoscopically if the lesion was
< 10 cm and there was no clinical evidence of malignancy. All 79 patients who underwent LA have been included in this study.
Among 152 patients who underwent OA at “La Sapienza” University in Rome, 93 had an adrenal lesion < 10 cm and no clinical
evidence of malignancy; they were selected for comparison. Multivariate analysis has been used to analyze the effect of the
surgical approach (OA vs. LA) on the surgical outcome, controlling for potential confounders. Multiple logistic regression
showed that there is no significant difference in intraoperative outcomes (i.e., surgical time > 2 hours, blood loss ≥ 500
ml) between patients operated on through a traditional approach and those who underwent LA. On the other hand, patients operated
on laparoscopically have a significantly higher probability than the OA group of experiencing a better recovery from surgery
(i.e., require less postoperative analgesics and return to normal activities earlier). The results of the present study show
that, although LA does not add much benefit in terms of expected intraoperative outcomes, it dramatically speeds patients’
recovery from surgery. The two approaches are complementary and should both be integrated into the technical background of
all endocrine surgeons. |
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