Abstract
Background
We sought to determine whether obesity is correlated with complications after posterior
retroperitoneoscopic adrenalectomy for benign diseases and to develop surrogate markers
of abdominal fat in preoperative computed tomography.
Methods
We conducted a retrospective chart review of all patients who had undergone posterior
retroperitoneoscopic adrenalectomy and preoperative computed tomography between January
1, 2008 and December 31, 2015. The cross-sectional components of fat assessed by computed
tomography included total fat area, subcutaneous fat area, retroperitoneal fat area,
and peritoneal fat area. The patients were grouped into 2 categories according to
the absence or presence of a postoperative complication (the no-complications group
and the complications group, respectively).
Results
Of 116 study patients, 20 patients (17%) had a postoperative complication. Operations
of greater duration and smaller adrenal gland size were significantly correlated with
complications both in univariate and multivariate analyses. Body mass index, total
fat area, subcutaneous fat area, retroperitoneal fat area, peritoneal fat area, and
distance of skin to muscle (in axial and sagittal images) correlated with complications
in univariate analysis but not in multivariate analysis. In the no-complications group,
the removed adrenal gland was larger than that removed in the complications group
(6 vs 4 cm, respectively, P = .001), whereas the complications group had a greater operative duration (139 vs
104 min, respectively, P = .001) and a greater duration of hospital stay (3 days vs 1 day, respectively, P = .001).
Conclusion
In this study, operations of greater duration and smaller adrenal gland size were
better predictors of complications after posterior retroperitoneoscopic adrenalectomy
for benign disease than measures of obesity, including body mass index.
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References
- Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma.N Engl J Med. 1992; 327: 1033
- Laparoscopic left adrenalectomy for aldosteronoma: early Mayo Clinic experience.Mayo Clin Proc. 1995; 70: 844-846
- Endoscopic retroperitoneal adrenalectomy.Surgery. 1995; 118 (discussion 5–6): 1071-1075
- Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: results of 30 adrenalectomies in 27 patients.World J Surg. 1996; 20: 769-774
- Hemodynamic changes after retroperitoneal CO2 insufflation for posterior retroperitoneoscopic adrenalectomy.Anesth Analg. 1996; 82: 827-831
- Posterior retroperitoneoscopic adrenalectomy—results of 560 procedures in 520 patients.Surgery. 2006; 140 (discussion 8–50): 943-948
- Retroperitoneoscopic or laparoscopic adrenalectomy? A single-centre UK experience.Surg Endosc. 2013; 27: 4147-4152
- Systematic review and meta-analysis of retroperitoneoscopic versus laparoscopic adrenalectomy.Br J Surg. 2012; 99: 1639-1648
- Posterior retroperitoneoscopic adrenalectomy is a safe and effective alternative to transabdominal laparoscopic adrenalectomy for pheochromocytoma.Surgery. 2011; 150: 452-458
- Posterior retroperitoneoscopic adrenalectomy: a contemporary American experience.J Am Coll Surg. 2011; 212 (discussion 65–7): 659-665
- Posterior retroperitoneoscopic adrenalectomy: preferred technique for removal of benign tumors and isolated metastases.Ann Surg. 2008; 248: 666-674
- On “Posterior retroperitoneoscopic adrenalectomy—results of 560 procedures in 520 patients.”.Surgery. 2006; 140: 951-952
- Single-incision retroperitoneoscopic adrenalectomy: a North American experience.Surg Endosc. 2017; 31: 3014-3019
- Minimally invasive approach for adrenal lesions: systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications.Int J Surg. 2016; 28: S118-S123
- Expanding the indications for laparoscopic retroperitoneal adrenalectomy: experience with 81 resections.J Surg Res. 2014; 187: 496-501
- The surgical approach to the adrenal gland: a comparison of the retroperitoneal and the transabdominal routes in 326 operations on 284 patients.Jpn J Clin Oncol. 2000; 30: 68-74
- Visceral obesity is a strong predictor of perioperative outcome in patients undergoing laparoscopic radical nephrectomy.BJU Int. 2012; 110: E980-E984
- Evaluation of the technical difficulty performing laparoscopic resection of a rectosigmoid carcinoma: visceral fat reflects technical difficulty more accurately than body mass index.Surg Endosc. 2007; 21: 929-934
- Impact of visceral obesity on outcomes of laparoscopic colorectal surgery: a meta-analysis.ANZ J Surg. 2015; 85: 507-513
- Comparison of open and laparoscopic nephrectomy in obese and nonobese patients: outcomes stratified by body mass index.J Urol. 2008; 180: 79-83
- Analysis of impact of body mass index on outcomes of laparoscopic renal surgery.Urology. 2007; 69: 38-43
- Increased complication rate in obese patients undergoing laparoscopic adrenalectomy.JSLS. 2012; 16: 45-49
- Laparoscopic transperitoneal adrenalectomy in morbidly obese patients is not associated with worse short-term outcomes.Int J Urol. 2017; 24: 59-63
- Should specific patient clinical characteristics discourage adrenal surgeons from performing laparoscopic transperitoneal adrenalectomy?.Surgery. 2016; 159: 240-248
- Impact of obesity on perioperative outcomes of retroperitoneal laparoscopic adrenalectomy.Urol Int. 2015; 95: 361-366
- Risk factors for perioperative complications of laparoscopic adrenalectomy including single-site surgery.J Endourol. 2012; 26: 1463-1467
- Impact of body mass index on outcomes of laparoscopic adrenal surgery.Surg Innov. 2011; 18: 358-367
- Obesity is a predictor of morbidity in 1,629 patients who underwent adrenalectomy.World J Surg. 2011; 35: 1287-1295
- Retroperitoneoscopic adrenalectomy in obese patients: is it suitable?.Obes Surg. 2015; 25: 1203-1208
- Visceral fat is correlated with prolonged operative time in laparoendoscopic single-site adrenalectomy and laparoscopic adrenalectomy.Urology. 2013; 82: 1312-1318
- Predictive value of retroperitoneal fat area measurement for detecting metabolic syndrome in patients undergoing adrenalectomy.World J Surg. 2011; 35: 986-994
- The effect of retroperitoneal fat mass on surgical outcomes in patients performing laparoscopic adrenalectomy: the effect of fat tissue in adrenalectomy.Surg Innov. 2010; 17: 114-119
- Posterior retroperitoneoscopic adrenalectomy.Adv Surg. 2009; 43: 147-157
- Retroperitoneoscopic adrenalectomy for pheochromocytoma in a morbidly obese.Obes Surg. 2009; 19: 1180-1182
- Retroperitoneoscopic adrenalectomy: lateral versus dorsal approach.J Surg Oncol. 2008; 97: 90-93
- Does laparoscopic adrenalectomy jeopardize oncologic outcomes for patients with adrenocortical carcinoma?.Surg Endosc. 2013; 27: 4026-4032
- Laparoscopic resection of adrenal cortical carcinoma: a cautionary note.Surgery. 2005; 138 (discussion 85–6): 1078-1085
Article info
Publication history
Published online: October 25, 2018
Accepted:
September 15,
2018
Received in revised form:
September 10,
2018
Received:
June 4,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
