Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis,Surgical Endoscopy

当前位置： X-MOL 学术 › Surg. Endosc. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Robot-assisted vs laparoscopic lateral transabdominal adrenalectomy: a propensity score matching analysis
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2022-10-03 , DOI: 10.1007/s00464-022-09663-3
Carmela De Crea _{1,

2} , Francesco Pennestrì _{1,

2} , Nikolaos Voloudakis ₁ , Luca Sessa _{2,

3} , Priscilla Francesca Procopio _{1,

2} , Pierpaolo Gallucci ₁ , Rocco Bellantone _{1,

2} , Marco Raffaelli _{1,

2}

Affiliation

Background

Laparoscopic adrenalectomy (LA) is the gold standard treatment for adrenal lesions. Robot-assisted adrenalectomy (RAA) is a safe approach, associated with higher costs in absence of clear-cut benefits. Several series reported some advantages of RAA over LA in challenging cases, but definitive conclusions are lacking. We evaluated the cost effectiveness and outcomes of robotic (R-LTA) and laparoscopic (L-LTA) approach for lateral transabdominal adrenalectomy in a high-volume center.

Methods

Among 356 minimally invasive adrenalectomies (January 2012–August 2021), 286 were performed with a lateral transabdominal approach: 191 L-LTA and 95 R-LTA. The R-LTA and L-LTA patients were matched for lesion side and size, hormone secretion, and BMI with propensity score matching (PSM) analysis. Postoperative complications, operative time (OT), postoperative stay (POS), and costs were compared.

Results

PSM analysis identified 184 patients, 92 in R-LTA and 92 in L-LTA group. The two groups were well matched. The median lesion size was 4 cm in both groups (p = 0.533). Hormonal hypersecretion was detected in 55 and 54 patients of R-LTA and L-LTA group, respectively (p = 1). Median OT was significantly longer in R-LTA group (90.0 vs 65.0 min) (p < 0.001). No conversion was registered. Median POS was similar (4.0 vs 3.0 days in the R-LTA and L-LTA) (p = 0.467). No difference in postoperative complications was found (p = 1). The cost margin analysis showed a positive income for both procedures (3137 vs 3968 € for R-LTA and L-LTA). In the multiple logistic regression analysis, independent risk factors for postoperative complications were hypercortisolism (OR = 3.926, p = 0.049) and OT > 75 min (OR = 8.177, p = 0.048).

Conclusions

The postoperative outcomes of R-LTA and L-TLA were similar in our experience. Despite the higher cost, RAA appears to be cost effective and economically sustainable in a high-volume center (60 adrenalectomies/year), especially if performed in challenging cases, including patients with large (> 6 cm) and/or functioning tumors.

Graphical abstract

中文翻译：

机器人辅助与腹腔镜侧经腹肾上腺切除术：倾向评分匹配分析

背景

腹腔镜肾上腺切除术（LA）是治疗肾上腺病变的金标准。机器人辅助肾上腺切除术（RAA）是一种安全的方法，但在缺乏明确效益的情况下成本较高。多个系列报道了在具有挑战性的病例中 RAA 相对于 LA 的一些优势，但缺乏明确的结论。我们评估了大容量中心采用机器人 (R-LTA) 和腹腔镜 (L-LTA) 方法进行侧经腹肾上腺切除术的成本效益和结果。

方法

在 356 例微创肾上腺切除术中（2012 年 1 月至 2021 年 8 月），286 例采用侧经腹手术：191 例 L-LTA 和 95 例 R-LTA。通过倾向评分匹配 (PSM) 分析，对 R-LTA 和 L-LTA 患者的病灶侧面和大小、激素分泌和 BMI 进行匹配。比较术后并发症、手术时间（OT）、术后停留时间（POS）和费用。

结果

PSM 分析确定了 184 名患者，其中 92 名患者为 R-LTA 组，92 名患者为 L-LTA 组。两组的匹配度很高。两组的中位病变大小均为 4 cm ( p = 0.533)。R-LTA 组和 L-LTA 组分别有 55 名和 54 名患者检测到激素分泌过多（p = 1）。R-LTA 组的中位 OT 明显更长（90.0 分钟 vs 65.0 分钟）（p < 0.001）。未注册任何转换。中位 POS 相似（R-LTA 和 L-LTA 中的 4.0 天与 3.0 天）（p = 0.467）。术后并发症没有发现差异（p = 1）。成本利润分析显示这两种手术都有积极的收入（R-LTA 和 L-LTA 分别为 3137 欧元和 3968 欧元）。在多元logistic回归分析中，术后并发症的独立危险因素是皮质醇增多症（OR = 3.926，p = 0.049）和OT > 75 min（OR = 8.177，p = 0.048）。