Clinical Outcomes and Predictive Factors in Adrenalectomy: A Retrospective Cohort Study

TL;DR

This study examines the outcomes of adrenalectomy surgery and identifies factors like tumor size and surgical approach that influence treatment success.

Contribution

The study identifies clinical and pathological predictors of adrenalectomy outcomes, including tumor characteristics and surgical approach.

Findings

Malignancy was linked to larger tumor size, higher mitotic rate, necrosis, and vascular invasion.

Laparoscopic approach and shorter surgery duration were associated with better treatment response.

Absence of capsular invasion and adenoma pathology improved treatment outcomes.

Abstract

Adrenal tumors present a notable prevalence of 4-7% in individuals above 40 years old. Current guidelines recommend adrenalectomy for hormone-secreting, potentially malignant, or large (>4 cm) lesions. However, the outcomes of adrenalectomy and their clinical-pathological associations remain poorly defined. This study assessed adrenalectomy outcomes and explored its clinical, demographic, and pathologic correlates.

In this retrospective cohort study, the medical records of all patients who underwent adrenalectomy from March 2016 to March 2021 at a referral center in Tehran were reviewed. Also, a clinical follow-up via telephone was conducted. The chi-square test, independent t-test, and analysis of variance were utilized for statistical analysis.

Data from a total of 75 patients (55 females) were reviewed. The mean age of the participants was 42.67 years. Of them, 60%, 22.7%, 14.7%, and 1.3% had pheochromocytoma, Cushing's syndrome, Conn's syndrome, and insulinoma, respectively. Malignancy was associated with greater tumor size (p<0.000) and mitotic rate (p=0.046), and the presence of necrosis (p=0.001), and capsular and vascular invasion (p<0.000). Clinical follow-up visits of 45 patients indicated 84.4% showed a complete response to the treatment (surgical ± medical). Treatment response was significantly influenced by approach (laparoscopic favored; p=0.001), surgery duration (<150 minutes better; p=0.017), mass pathology (adenoma favored; p=0.034), and capsular invasion (absence better; p=0.012).

Adrenalectomy outcomes were significantly affected by surgical approach and tumor pathology, notably capsular invasion. Larger studies are needed to determine the predictive values of clinical and pathologic variables in adrenalectomy for adrenal tumors.

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