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J Surg Oncol. 2019 May;119(6):801-806. doi: 10.1002/jso.25364. Epub 2019 Jan 30.

Retrospective analysis of variant venous anatomy in 303 laparoscopic adrenalectomies and its clinical implications.

Sun F1, Zhuo R1, Ma W1, He H1, Ye L2,3, Xu D1, Wang W2,3, Ning G2,3.

Author information

1
Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
2
Shanghai Key Laboratory for Endocrine Tumors, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of Chinese Health Ministry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
3
Laboratory for Endocrine & Metabolic Diseases of Institute of Health Science, Shanghai Jiao Tong University School of Medicine and Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.

Abstract

BACKGROUND AND OBJECTIVES:

To clarify the correlation of variant venous anatomy with adrenal tumor phenotype and surgical outcomes.

PATIENTS AND METHODS:

This retrospective study included 303 consecutive minimally invasive adrenalectomies from 301 patients. All adrenal veins were identified. We compared the preoperative, intraoperative, and postoperative data between patients with and without variant adrenal venous anatomy. We also explored the factors associated with venous variants.

RESULTS:

We found variant venous anatomy in 62 of 303 adrenalectomies (20.5%). Compared with patients with normal anatomy, those with variant anatomy were associated with larger tumor size, larger adrenal veins, more adrenal medullary tumors, longer operation time, more estimated intraoperative blood loss, longer length of hospitalization, and more transfusion. Computed tomography (CT) images may improve the identification of venous anatomy. Tumor size and diagnosis of pheochromocytoma were independently related to variant venous anatomy, whereas sex, tumor size, and venous variant influenced hemorrhage. For pheochromocytoma with variant venous anatomy operated on by a single surgeon, robot-assisted laparoscopic adrenalectomy was associated with shorter postoperative hospitalization.

CONCLUSIONS:

Adrenal vein variants are associated with worse outcomes in adrenal tumors and an optimized surgery strategy should be applied to this group of patients.

KEYWORDS:

adrenal tumors; robot-assisted laparoscopic adrenalectomy; surgical outcomes; variant venous anatomy

PMID:
30697735
DOI:
10.1002/jso.25364
[Indexed for MEDLINE]

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