Effect of preoperative computed tomography parameters and obesity on surgical outcomes of laparoendoscopic single-site adrenalectomy
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The aims of the present study were to (1) analyse preoperative computed tomography (CT) parameters, (2) investigate whether obesity and CT parameters affect surgical outcomes in patients undergoing LESS lateral retroperitoneal adrenalectomy, and (3) further establish the optimal cutoff point of CT parameters for tolerable operating time.
Between January 2010 and August 2016, patients who underwent LESS adrenalectomy through the retroperitoneal approach in our hospitals were included. Patients’ demographic data, preoperatively measured CT parameters (the depth and horizontal width to the adrenal gland in the axial view of abdominal CT, the vertical height in the coronal view of CT, and the angle of the depth and horizontal width), and intraoperative (operative time and blood loss) and postoperative (hospital stay and complications) parameters were retrospectively reviewed. Linear regression was performed to determine factors that potentially affect surgical outcomes.
In 116 patients, depth was the only CT parameter associated with surgical outcomes. Large depth (P = 0.005; 95% CI 1.739–9.256) and high BMI (P = 0.012; 95% CI 0.357–2.851) were factors significantly associated with longer operative time. The area under the ROC curve for the depth was 0.69 (P = 0.002), and the cutoff point 10.48 cm may be the tolerable operating time.
Our results suggest a depth limit of 10.48 cm for the optimal prediction of operating time less than 90 min; although obese patients and deeper adrenal glands had longer operative time, LESS adrenalectomy could be performed in the obese patients without increased blood loss, prolonged hospital stay, or increased pain.
KeywordsAdrenalectomy Laparoscopy Obesity Treatment outcome Computed tomography
Y-CC: manuscript writing, literature search and data interpretation. H-YL: literature search, data interpretation and corrections to the report. M-CPS: data interpretation. Y-SJ: data interpretation and corrections to the report. H-WC: manuscript writing, literature search and figure editing. W-JW: data interpretation and corrections to the report. Y-TW: statistical data analysis. C-CL: data interpretation and corrections to the report. All authors were equally involved in clinical diagnosis and management of the patient. All authors have approved the final version of the manuscript. Written informed consent to publication was obtained.
All authors (Yu-Chen Chen, Hsiang-Ying Lee, Ming-Chen Paul Shih, Yung-Shun Juan, Hao-Wei Chen, Wen-Jeng Wu, Yu-Tsang Wang and Ching-Chia Li) declare that they have no funding.
Compliance with ethical standards
Yu-Chen Chen, Hsiang-Ying Lee, Ming-Chen Paul Shih, Yung-Shun Juan, Hao-Wei Chen, Wen-Jeng Wu, Yu-Tsang Wang and Ching-Chia Li declare that they have no conflict of interest.
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