Contemporary Experience of Posterior Retroperitoneoscopic Adrenalectomy in the US.

Abstract

BACKGROUND\nAs the incidence of adrenalectomy steadily increases, so do the utilization of minimally invasive approaches like the Posterior Retroperitoneoscopic Adrenalectomy (PRA). To date, the largest studies of PRA have been from abroad, and we sought to provide a contemporary American update on the outcomes following PRA.\n\n\nMETHODS\nA retrospective chart review was conducted on all PRAs performed at a single tertiary care institution between 2013 and 2020. Patient demographics, indication for surgery, operative details, and postoperative course were abstracted. Outcomes of interest included 30-day mortality, conversion to open or transabdominal approach, postoperative complication, and 30-day readmission.\n\n\nRESULTS\nA total of 249 RPA were performed between 2013 and 2020. The population was 54.2% female with an average age of 54.1 (SD 14.1). Most (60.6%) lesions were left-sided, and the most common diagnosis was non-functioning adenoma (39.4%), followed by pheochromocytoma (21.3%) and aldosteronoma (16.6%). The average tumor size was 3.2 cm (SD 1.7) with a range from 0.5 to 9.4 cm. The average operative length was 110 minutes (Range 30-319 minutes). Overall, the complication rate was 6.4%. Nine (3.6%) patients had a minor postoperative complication (Clavien-Dindo I-III), while five patients (2.0%) had a major postoperative complication (Clavien-Dindo IV-V), including one mortality (0.4%). There were two conversions of approach (0.8%). The majority (58.2%) of patients were discharged on postoperative day one, and 92.0% were discharged by postoperative day three. The 30-day readmission rate was 1.6%.\n\n\nCONCLUSION\nCurrent practice demonstrates that RPA is an extremely safe approach, with a complication rate under 7% and mortality under 1%. Additionally, the vast majority of patients are able to return home in an expedient manner.