PD07-07 PREDICTING SURGICAL OUTCOME IN POSTERIOR RETROPERITONEOSCOPIC ADRENALECTOMY BASED ON PREOPERATIVE PATIENT CHARACTERISTICS

Abstract

You have accessJournal of UrologyAdrenal (PD07)1 Sep 2021PD07-07 PREDICTING SURGICAL OUTCOME IN POSTERIOR RETROPERITONEOSCOPIC ADRENALECTOMY BASED ON PREOPERATIVE PATIENT CHARACTERISTICS Allon van Uitert, Elle van de Wiel, Jordache Ramjith, Jaap Deinum, Henri Timmers, Alfred Witjes, Leo Schultze Kool, and Johan Langenhuijsen Allon van UitertAllon van Uitert More articles by this author , Elle van de WielElle van de Wiel More articles by this author , Jordache RamjithJordache Ramjith More articles by this author , Jaap DeinumJaap Deinum More articles by this author , Henri TimmersHenri Timmers More articles by this author , Alfred WitjesAlfred Witjes More articles by this author , Leo Schultze KoolLeo Schultze Kool More articles by this author , and Johan LangenhuijsenJohan Langenhuijsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001975.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior retroperitoneal adrenalectomy (PRA) shows several advantages over the transabdominal approach (TLA), including shorter operating time, less postoperative pain, faster recovery, improved cost-effectiveness, and abolished risk of access site herniation. To improve adequate patient selection, a nomogram was developed to predict surgical outcome of PRA. METHODS: All consecutive patients who underwent unilateral PRA by one surgeon between February 2011 and March 2020 were included in the study. Patients were eligible for PRA with a body mass index (BMI) of <35 kg/m2, tumor diameter ≤7 cm, and with low suspicion of malignancy. Since the number of complications and conversions are generally low, the primary outcome of PRA was operating time (OT) as surrogate endpoint for surgical complexity. We hypothesize that with an OT >90 minutes, which accounts for ±18% of the procedures, PRA is less profitable and TLA may be the better choice, as it offers larger working space and more anatomical landmarks. To create an optimal prediction model, 10 patient variables were used. These included 6 radiological measurements on preoperative CT-scans to measure the amount of retroperitoneal fat and the position of the adrenal tumor. A best subsets regression analysis was performed to find the best 1-variable model up to the best 10-variables model. RESULTS: In total, 215 patients were included in this study. The mean age was 51.6±12.2 years, 49% were male, and mean tumor diameter was 2.4±1.6 cm. After best subset regression analysis, a 4-variable nomogram was selected (Figure 1a). This model included sex, pheochromocytoma, BMI and perinephric fat, which were all individually significant predictors. An example of applying the model is shown in Figure 1b, which shows a predicted OT of 87 minutes. The model showed an ideal balance between predictive power and applicability, with an R2 of 38.6, i.e. 39% of the variation in OT is reliably explained by this model. CONCLUSIONS: A new 4-variable nomogram was developed to predict outcome in PRA, which may aid the surgeon to preoperatively identify the patients in which PRA is feasible. When predicted OT exceeds 90 minutes, indicating high-complex surgery, TLA could be the preferred technique. Source of Funding: Radboudumc © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e107-e108 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Allon van Uitert More articles by this author Elle van de Wiel More articles by this author Jordache Ramjith More articles by this author Jaap Deinum More articles by this author Henri Timmers More articles by this author Alfred Witjes More articles by this author Leo Schultze Kool More articles by this author Johan Langenhuijsen More articles by this author Expand All Advertisement Loading ...