Kevin Verhoeff, Alessandro Parente, Yanbo Wang, Nanya Wang, Zhicheng Wang, Maciej Śledziński, Andrzej Hellmann, Marco Raffaelli, Francesco Pennestrì, Mark Sywak, Alexander J Papachristos, Fausto F Palazzo, Tae-Yon Sung, Byung-Chang Kim, Yu-Mi Lee, Fiona Eatock, Hannah Anderson, Maurizio Iacobone, Albertas Daukša, Ozer Makay, Yigit Turk, Hafize Basut Atalay, Els J M Nieveen van Dijkum, Anton F Engelsman, Isabelle Holscher, Gabriele Materazzi, Leonardo Rossi, Chiara Becucci, Susannah L Shore, Clare Fung, Alison Waghorn, Radu Mihai, Sabapathy P Balasubramanian, Arslan Pannu, Shuichi Tatarano, David Velázquez-Fernández, Julie A Miller, Hazel Serrao-Brown, Yufei Chen, Marco Stefano Demarchi, Reza Djafarrian, Helen Doran, Kelvin Wang, Michael J Stechman, Helen Perry, Johnathan Hubbard, Cristina Lamas, Philippa Mercer, Janet MacPherson, Supanut Lumbiganon, María Calatayud, Felicia Alexandra Hanzu, Oscar Vidal, Marta Araujo-Castro, Cesar Minguez Ojeda, Theodosios Papavramidis, Pablo Rodríguez de Vera Gómez, Abdulaziz Aldrees, Tariq Altwjry, Nuria Valdés, Cristina Álvarez-Escola, Iñigo García Sanz, Concepción Blanco Carrera, Laura Manjón-Miguélez, Paz De Miguel Novoa, Mónica Recasens, Rogelio García Centeno, Cristina Robles Lázaro, Klaas Van Den Heede, Sam Van Slycke, Theodora Michalopoulou, Sebastian Aspinall, Ross Melvin, Joel Wen Liang Lau, Wei Keat Cheah, Man Hon Tang, Han Boon Oh, John Ayuk, Robert P Sutcliffe
{"title":"Outcomes for Patients with Obesity Undergoing Adrenalectomy for Pheochromocytoma: An International Multicenter Analysis.","authors":"Kevin Verhoeff, Alessandro Parente, Yanbo Wang, Nanya Wang, Zhicheng Wang, Maciej Śledziński, Andrzej Hellmann, Marco Raffaelli, Francesco Pennestrì, Mark Sywak, Alexander J Papachristos, Fausto F Palazzo, Tae-Yon Sung, Byung-Chang Kim, Yu-Mi Lee, Fiona Eatock, Hannah Anderson, Maurizio Iacobone, Albertas Daukša, Ozer Makay, Yigit Turk, Hafize Basut Atalay, Els J M Nieveen van Dijkum, Anton F Engelsman, Isabelle Holscher, Gabriele Materazzi, Leonardo Rossi, Chiara Becucci, Susannah L Shore, Clare Fung, Alison Waghorn, Radu Mihai, Sabapathy P Balasubramanian, Arslan Pannu, Shuichi Tatarano, David Velázquez-Fernández, Julie A Miller, Hazel Serrao-Brown, Yufei Chen, Marco Stefano Demarchi, Reza Djafarrian, Helen Doran, Kelvin Wang, Michael J Stechman, Helen Perry, Johnathan Hubbard, Cristina Lamas, Philippa Mercer, Janet MacPherson, Supanut Lumbiganon, María Calatayud, Felicia Alexandra Hanzu, Oscar Vidal, Marta Araujo-Castro, Cesar Minguez Ojeda, Theodosios Papavramidis, Pablo Rodríguez de Vera Gómez, Abdulaziz Aldrees, Tariq Altwjry, Nuria Valdés, Cristina Álvarez-Escola, Iñigo García Sanz, Concepción Blanco Carrera, Laura Manjón-Miguélez, Paz De Miguel Novoa, Mónica Recasens, Rogelio García Centeno, Cristina Robles Lázaro, Klaas Van Den Heede, Sam Van Slycke, Theodora Michalopoulou, Sebastian Aspinall, Ross Melvin, Joel Wen Liang Lau, Wei Keat Cheah, Man Hon Tang, Han Boon Oh, John Ayuk, Robert P Sutcliffe","doi":"10.1245/s10434-024-16591-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The impact of obesity on outcomes after adrenalectomy for pheochromocytoma is unclear. This study aims to evaluate outcomes after minimally invasive and open adrenalectomy for pheochromocytoma in patients with obesity and to determine factors that may affect outcomes. Patients undergoing adrenalectomy for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed, analyzing baseline information, length of hospital stay (LOS), and postoperative complications.</p><p><strong>Patients and methods: </strong>Obese (body mass index (BMI) ≥ 30 kg/m<sup>2</sup>) and nonobese patients were compared. Multivariable analysis was utilized to evaluate outcomes and risk factors for complications, LOS, and increased comprehensive complication index (CCI).</p><p><strong>Results: </strong>Of the 2016 patients, 639 (31.7%) had obesity. Operative time (110.0 versus 105.0 min; p = 0.467), conversion to open rate (3.1% versus 4.7%; p = 0.079), estimated blood loss (20.0 versus 20.0 ml, p = 0.088), rate of complications (19.3% versus 20.8%; p = 0.425), and CCI were similar. However, patients with obesity required a median of 1 day longer LOS (4.0 days versus 5.0 days; p < 0.001). On multivariable analysis, obesity was not significantly associated with complications or higher CCI. Analyzing solely obese patients, laparoscopic (OR 0.24; p < 0.001) and robotic (OR 0.22; p = 0.011) approaches were independently associated with less morbidity. Additionally, multivariable modeling demonstrated that a retroperitoneal approach in patients with BMI ≥ 30 kg/m<sup>2</sup> was independently associated with reduced CCI (- 3.74; p = 0.017). Similar results were demonstrated when analyzing severe obesity (BMI ≥ 35).</p><p><strong>Conclusions: </strong>Obesity does not increase complications or CCI following pheochromocytoma resection, but it does increase LOS. A retroperitoneal approach may uniquely benefit patients with obesity. In view of rising obesity rates, these results warrant further research to validate findings.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"1709-1720"},"PeriodicalIF":3.4000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1245/s10434-024-16591-0","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/4 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: The impact of obesity on outcomes after adrenalectomy for pheochromocytoma is unclear. This study aims to evaluate outcomes after minimally invasive and open adrenalectomy for pheochromocytoma in patients with obesity and to determine factors that may affect outcomes. Patients undergoing adrenalectomy for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed, analyzing baseline information, length of hospital stay (LOS), and postoperative complications.
Patients and methods: Obese (body mass index (BMI) ≥ 30 kg/m2) and nonobese patients were compared. Multivariable analysis was utilized to evaluate outcomes and risk factors for complications, LOS, and increased comprehensive complication index (CCI).
Results: Of the 2016 patients, 639 (31.7%) had obesity. Operative time (110.0 versus 105.0 min; p = 0.467), conversion to open rate (3.1% versus 4.7%; p = 0.079), estimated blood loss (20.0 versus 20.0 ml, p = 0.088), rate of complications (19.3% versus 20.8%; p = 0.425), and CCI were similar. However, patients with obesity required a median of 1 day longer LOS (4.0 days versus 5.0 days; p < 0.001). On multivariable analysis, obesity was not significantly associated with complications or higher CCI. Analyzing solely obese patients, laparoscopic (OR 0.24; p < 0.001) and robotic (OR 0.22; p = 0.011) approaches were independently associated with less morbidity. Additionally, multivariable modeling demonstrated that a retroperitoneal approach in patients with BMI ≥ 30 kg/m2 was independently associated with reduced CCI (- 3.74; p = 0.017). Similar results were demonstrated when analyzing severe obesity (BMI ≥ 35).
Conclusions: Obesity does not increase complications or CCI following pheochromocytoma resection, but it does increase LOS. A retroperitoneal approach may uniquely benefit patients with obesity. In view of rising obesity rates, these results warrant further research to validate findings.
期刊介绍：
The Annals of Surgical Oncology is the official journal of The Society of Surgical Oncology and is published for the Society by Springer. The Annals publishes original and educational manuscripts about oncology for surgeons from all specialities in academic and community settings.
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