Tae-Yon Sung, M.D., Ph.D.: No financial relationships to disclose
Background: A prolonged operative time is an important indicator of surgical complexity in retroperitoneal adrenalectomy. This study evaluated the parameters underlying a prolonged operation time in patients undergoing a posterior retroperitoneal adrenalectomy (PRA) for pheochromocytoma, including the abdominal circumference (AC) and body mass index (BMI) as predictive values.
Materials and methods: We retrospectively analyzed patients who underwent laparoscopic or robotic PRA for pheochromocytoma between 2017 and 2021. Clinical and radiologic variables were evaluated to identify predictors of a prolonged operative time.
Results: Among 159 patients who underwent PRA, 40 (25%) had a prolonged operative time, corresponding to the highest quartile (≥114 minutes). Patients with an AC ≥90 cm, the optimal cutoff identified by receiver operating characteristic curve analysis, had a significantly longer operative time and a higher proportion of prolonged procedures. In multivariate analysis, AC ≥90 cm (OR 4.019; 95% CI 1.841–8.772) and tumor size remained independent predictors, whereas BMI did not retain significance. Predictive performance improved notably when AC ≥90 cm was added to a simple clinical model of age, sex, and tumor size, but there was no further gain by including BMI.
Conclusion: AC is an independent and practical predictor of prolonged operative time in pheochromocytoma patients undergoing PRA. Incorporating AC along with basic clinical factors may enhance the preoperative estimation of operative difficulty and thereby support perioperative planning.
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