Laparoscopic Adrenalectomy for Large Adrenal Tumors.

Study Overview
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Brief Summary
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Laparoscopic adrenalectomy is the treatment of choice for the benign tumor of less than 6 cm. However, this is an ongoing debate that exact cut-off value of tumor size for LA. The aim of this study was to assess whether the size of the adrenal tumor affects preoperative and postoperative outcomes in patients undergoing laparoscopic transperitoneal adrenalectomy as well as to evaluate the learning curve.

Detailed Description
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From April 2010 to October 2018, preoperative and postoperative data of 107 patients who underwent LTA with adrenal mass were recorded prospectively and analyzed retrospectively. The inclusion criteria were all hormonally active adrenal lesions, detection of increases in size in < 4 cm adrenal tumors on serial imaging, solitary adrenal metastases without evidence of local invasion, tumors size ≥ 4 cm, patients between the age of 18 and 80, and American Society of Anesthesiologists score (ASA) ≤ 3. The patients with adrenal masses that specified suspicion of malignancy on imaging such as local invasion, irregular tumor margins were evaluated as ineligible for LTA, and excluded in this study, were addressed to open surgery. Retroperitoneoscopic and laparoscopic partial adrenalectomies were also excluded from the study. Totally 102 patients were included in the study. The patients were allocated according to adrenal tumor size as <6cm (group 1:76) and ≥ 6 cm (group 2: 26). The variables such as demographics, tumor size, and laterality, operation time, blood loss, per-operative and postoperative complications, length of hospital stay, final pathology result were compared between the two groups. In order to evaluate the learning curve, the patients were also classified into three consecutive groups including group A (1-25), group B (25-50), group C (51-75) and group D (76-102) according to the chronological order of their surgery. Variables including operation time, tumor size, blood loss, and hospital stay, and overall complications were used to investigate the learning curve.

Official Title
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Is There Anything New in the Field of Large Adrenal Tumors ?

Conditions
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Adrenal Tumor, Adrenal Adenoma

Intervention / Treatment
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* Procedure: Laparoscopic Adrenalectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: all hormonally active adrenal lesions, detection of increases in size in < 4 cm adrenal tumors on serial imaging, solitary adrenal metastases without evidence of local invasion, tumors size ≥ 4 cm, patients between the age of 18 and 80 American Society of Anesthesiologists score (ASA) ≤ 3. Exclusion Criteria: suspicion of malignancy on imaging such as local invasion, irregular tumor margins Retroperitoneoscopic adrenalectomies laparoscopic partial adrenalectomies

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group 1<br>laparoscopic adrenalectomy group 1: tumor size as < 6 (group1) | Procedure: Laparoscopic Adrenalectomy<br>* minimally invasive lateral transperitoneal adrenalectomy<br>|
| Group 2<br>Laparoscopic adrenalectomy group2: tumor size ≥ 6 cm (group2) | Procedure: Laparoscopic Adrenalectomy<br>* minimally invasive lateral transperitoneal adrenalectomy<br>|
| Learning Curve<br>The patients, underwent laparoscopic adrenalectomy, were also classified into group A (1-25), B (26-50), C (51-75), and D (76-102) according to the chronological order of their surgery in order to evaluate the learning curve. | Procedure: Laparoscopic Adrenalectomy<br>* minimally invasive lateral transperitoneal adrenalectomy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Operation time | time from onset to complete of operation | intraoperative (minute) | 
| Blood loss | amount of bleeding during surgery (milliliter) | intraoperative | 
| hospitalization | duration of postoperative hospital stay | 1 day | 
| Complication | abnormal conditions during or after surgery | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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endocrine surgery; laparoscopic adrenalectomy;