Adrenal surgery: single center 10+10 years experience

Aim of this study is to compare two decade data of adrenal surgery - before and after multidisciplinary team meetings (MDT) were implemented in daily practice. Retrospective 252 patients' data who underwent adrenalectomy in Pauls Stradins Clinical university hospital  were analysed regarding surgery type, time, morphology, perioperative complications. Differences between period prior and after MDT meetings were implemented (2009) in adrenal management were estimated. Mean patient age was 54.8 (19-83) years, predominantly female - 186 (73.8%) vs 66 (26.2%) male. Indications for adrenalectomy were in first and second decade respectively: hormonally active tumors 32 (25.4%) vs 69 (54.8%), hormonally inactive - 89 (70.6%) vs 47 (37.3%) and malignancy 5 (4.0%) vs 10 (7.9%). Laparoscopic adrenalectomy (LA) was method of choice performed in 202 (80.2%) cases, open (OA) in 41 (16.2%) cases, 9 (3.6%) operations were converted (CA). LA prevalence tend to increase over last decade - 92 (73.0%) vs 110 (87.3%) but CA to decrease - 6 (4.8%) vs 3 (2.4%). Mean operation time has decreased - 112±42 vs 88±26 min. Morphology revealed 141 (56.0%) adrenocortical adenoma, 37 (15.1%) benign pheochromocytomas, 13 (5.3%) malignant pheochromocytomas, 12 (4.9%) Mts, 11 (4.4%) ACC and 38 (12.3%) cases of various other rare pathologies. Malignancy rate tend to increase - 8 (6.4%) in the first decade vs 28 (22.2%) in second. Perioperative complication rate decreased from 16 (12.7%) to 11 (8.7%). Adrenal surgery outcome and perioperative complications are associated with learning curve and experience. MDT meetings are highly recommended to select patients for surgery.