Med Bull Sisli Etfal Hosp. 2021; 55(3): 325-332 | DOI: 10.14744/SEMB.2021.13845

Hormonally Active Adrenal tumors; Challenges and Outcomes for Different Surgical Approaches

Husnu Aydin¹, Ahmet Cem Dural¹, Nuri Alper Sahbaz¹, Sezer Bulut¹, Deniz Guzey¹, Cevher Akarsu¹, Evin Bozkur², Mehmet Karabulut^1
1Department of General Surgery, Bakýrkoy Dr Sadi Konuk Training and Research Hospital, Ýstanbul, Turkey
²Department of Endocrinology, Bakýrkoy Dr Sadi Konuk Training and Research Hospital, Ýstanbul, Turkey

Objective: The aim of this study is to compare the intraoperative and short-term outcomes of different surgical approaches for hormone active and non-functional adrenal masses.
Methods: The data of 206 patients who underwent adrenal gland surgery in our clinic between 2012 and 2020 were retrospectively analyzed. Pre-operative outpatient clinic records of the patients, imaging methods, laboratory results and surgery records, operation time (OT), amount of bleeding, duration of hospital stay, and complications were evaluated. Patients were divided into two groups as those with non-functional mass (n=80) and those with hormoneactive mass (n=126).
Results: The median age of the patients was 52 (range 19–83) and 77.2% of them were female. Tumor size was larger in hormone active group (p=0.311), and the difference was more pronounced in the pheochromocytoma subgroup (p=0.088). The rate of transition to open surgery was similar in both groups (0.959), and no conversion to laparoscopy or conventional open surgery was performed in robotic cases. The duration of surgery (p=0.669), mean amount of blood loss (p=0.834), and mean hospital stay (p=0.195) were also similar between the two groups. Intraoperative and post-operative complications were similar between two groups (p=0.573 and p=0.415, respectively). Considering the subgroup analysis of the patients in hormone active group; the duration of hospital stay was longer in patients with Cushing syndrome (p=0.001), while there was no difference in OT and estimated blood loss between patients who were operated for Conn, Cushing, and pheochromocytoma (p=0.086 and p=0.099; respectively).
Conclusion: Surgical results of hormone active adrenal masses were found to be similar to non-functional masses. Although the hormonal condition of the mass does not change the difficulty level of the surgical procedure, it may be recommended that the robotic approach be preferred to facilitate manipulation in these masses.

Keywords: Adrenal gland surgery, hormone active adrenal mass; minimally invasive surgery.

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Adrenal Bez Cerrahisinde Kitlenin Hormon Aktif Olmasý Cerrahiyi Zorlaþtýrýr mý?

Husnu Aydin¹, Ahmet Cem Dural¹, Nuri Alper Sahbaz¹, Sezer Bulut¹, Deniz Guzey¹, Cevher Akarsu¹, Evin Bozkur², Mehmet Karabulut^1
1Bakýrköy Dr Sadi Konuk Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniði, Ýstanbul
²Bakýrköy Dr Sadi Konuk Eðitim ve Araþtýrma Hastanesi Endokrinoloji Kliniði, Ýstanbul

Amaç: Hormon aktif ve fonksiyonel olmayan adrenal kitlelerde farklý cerrahi yaklaþýmlarýn intraoperatif ve kýsa dönem sonuçlarýný karþýlaþtýrmak.
Yöntem: 2012-2020 yýllarý arasýnda kliniðimizde adrenal bez cerrahisi geçiren 206 hastanýn verileri retrospektif olarak incelendi. Hastalara ait ameliyat öncesi poliklinik kayýtlarý, görüntüleme yöntemleri, laboratuvar sonuçlarý ve ameliyat kayýtlarý, ameliyat süreleri, kanama miktarý, hastanede kalýþ süresi, komplikasyonlar deðerlendirildi. Hastalar, non-fonksiyonel kitlesi olanlar (n=80) ve hormon-aktif kitlesi olanlar (n=126) þeklinde 2 gruba ayrýldý.
Bulgular: Hastalarýn yaþ ortalamasý 56,5 (19-83) olup %77,2’si kadýndý. Ýki grup arasýnda demografik bulgular benzerdi. Kitle boyutlarý fonksiyonel kitlelerde daha büyük olup (p=0,311), feokromositoma alt grubunda fark daha belirgindi (p=0,088). Her iki grupta açýk cerrahiye geçiþ oraný benzer olup (0,959), robotik olgularda laparoskopi veya konvansiyonel açýk cerrahiye geçiþ yapýlmadý. Ýki grup arasýnda, ameliyat süresi (p=0,669), ortalama kan kaybý miktarý (p=0,834) ve ortalama hastanede kalýþ süresi de benzerdi (p=0,195). Hormon aktif grupta yer alan hastalarýn alt grup analizlerine bakýldýðýnda; Conn, Cushing ve Feokromositoma nedeniyle ameliyat edilen hastalar arasýnda ameliyat süresi ve tahmini kan kaybý açýsýndan fark saptanmazken (p=0,086 ve p=0,099; sýrasýyla), hastanede yatýþ süresi Cushing’li hastalarda daha uzun olarak bulundu (p=0,001).
Sonuç: Hormon aktif adrenal kitlelerin cerrahi sonuçlarý non-fonksiyonel kitlelerle benzer olarak bulunmuþtur. Kitlenin hormonal durumunun cerrahi prosedürün zorluk derecesini deðiþtirmediði düþünülmekle birlikte robotik yaklaþýmýn bu kitlelerde manipülasyonu kolaylaþtýrmak için tercih edilmesi düþünülmelidir. (SETB-2021-05-147)

Anahtar Kelimeler: Adrenal Bez Cerrahisi, Hormon aktif adrenal kitle, Minimal Ýnvaziv Cerrahi

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