Comparison of Perioperative Outcomes Between Laparoscopic and Robot-Assisted Adrenalectomy for Large Pheochromocytoma (≥ 5cm): A Retrospective Study

Figures & data

Table 1 Baseline Characteristics of Patients

Preoperative Data	Total (n=115)	Robotic Group (n=48)	Laparoscopic Group (n=67)	p-value
Age, year	45.0 (33.0–60.0)	43.5 (32.5–58.0)	45.0 (33.0–60.0)	0.563
Gender, n%				0.789
Male	52 (45.2)	21 (43.8)	31 (46.3)
Female	63 (54.8)	27 (56.3)	36 (53.7)
BMI, kg/m^2	22.9 (21.1–25.2)	23.1 (21.9–24.5)	22.6 (20.9–25.4)	0.854
Hypertension, n%	86 (74.8)	40 (83.3)	46 (68.7)	0.074
Diabetes, n%	23 (20.0)	9 (18.8)	14 (20.9)	0.777
Smoking, n%	8 (7.0)	2 (4.2)	6 (9.0)	0.533
Alcohol, n%	5 (4.3)	1 (2.1)	4 (6.0)	0.586
ASA, n%				0.143
1–2	99 (86.1)	44 (91.7)	55 (82.1)
3–4	16 (13.9)	4 (8.3)	12 (17.9)
CCI, n%				0.457
0–1	87 (75.7)	38 (79.2)	49 (73.1)
≥2	28 (24.3)	10 (20.8)	18 (26.9)
Prior abdominal surgery, n%	21 (18.3)	7 (14.6)	14 (20.9)	0.388
Preoperative hemoglobin, g/L	131.0 (118.0–139.0)	130.5 (117.0–137.0)	132.0 (120.5–142.5)	0.240
Preoperative albumin, g/L	41.0 (39.0–43.0)	41.0 (39.0–43.0)	41.0 (38.0–42.0)	0.157
Metanephrine, pg/mL	103.4 (67.1–718.9)	90.6 (62.9–553.3)	112.6 (71.2–1027.6)	0.392
Nor-Metanephrine, pg/mL	1200.9 (577.4–2630.5)	1701.6 (824.5–3252.9)	927.0 (337.9–2430.0)	0.045*
Tumor size, cm	6.0 (5.5–7.0)	6.0 (5.5–7.3)	6.0 (5.5–7.0)	0.551
Tumor Laterility, n%				0.274
Left	65 (56.5)	30 (62.5)	35 (52.2)
Right	50 (43.5)	18 (37.5)	32 (47.8)
Surgical Technique, n%				0.250
Transperitoneal	77 (67.0)	35 (72.9)	42 (62.7)
Retroperitoneal	38 (33.0)	13 (27.1)	25 (37.3)

Abbreviations: BMI, body mass index; ASA, American Society of Anesthesiologists score; CCI, Charlson comorbidity index.

Table 2 Perioperative Outcomes

Variables	Total (n=115)	Robotic Group (n=48)	Laparoscopic Group (n=67)	p-value
Conversion to open	3 (2.6)	0 (0.0)	3 (4.5)	0.372
OT, min	210.0 (180.0–250.0)	190.0 (170.0–215.0)	220.0 (190.0–260.0)	0.002*
EBL, mL	100.0 (50.0–200.0)	50.0 (30.0–212.5)	120.0 (100.0–200.0)	0.013*
Intraoperative complications	19 (16.5)	6 (12.5)	13 (19.4)	0.326
Intraop. ventricular fibrillation	1 (0.9)	1 (0.0)	0 (0.0)
Intraop. hypertension after removal of adrenal tumor, n%	10 (8.7)	2 (4.2)	8 (11.9)
Intraop. tissue or organ injury, requiring suture, n%	3 (2.6)	1 (2.1)	2 (3.0)
Cava vein damage with intracorporeal suture, n%	1 (0.9)	0 (0.0)	1 (1.5)
Significant bleeding in the surgical field, n%	2 (1.7)	1 (2.1)	1 (1.5)
Suspected spleen repture, requiring abdominal exploration, n%	1 (0.9)	0 (0.0)	1 (1.5)
Diaphragmatic rupture, requiring intraoperative suture, n%	1 (0.9)	1 (2.1)	0 (0.0)
Intraoperative transfusion	36 (31.3)	18 (37.5)	18 (26.9)	0.225
Postoperative complications	5 (4.3)	1 (2.1)	4 (6.0)	0.586
Postop. Electrolyte imbalance, n%	2 (1.7)	1 (2.1)	1 (1.5)
Postop. fever management with broad spectrum antibiotics, n%	1 (0.9)	0 (0.0)	1 (1.5)
Postop. pulmonary infection, n%	1 (0.9)	0 (0.0)	1 (1.5)
Postop. heart failure, n%	1 (0.9)	0 (0.0)	1 (1.5)
Postoperative transfusion, n%	27 (23.5)	13 (27.1)	14 (20.9)	0.440
Postoperative transfer to SICU	14 (12.2)	4 (8.3)	10 (14.9)	0.286
Postoperative hospital stay, day	13.0 (8.0–18.5)	12.5 (8.0–18.0)	13.0 (8.0–21.0)	0.980
Surgical expense (CNY)	9235.0 (7776.5–37323.3)	37933.0 (36725.0–38597.5)	7936.0 (6889.5–8829.0)	<0.001*
Postoperative MN, pg/mL	32.1 (17.3–50.3)	32.1 (23.7–41.5)	33.1 (16.0–50.9)	0.772
Postoperative NMN, pg/mL	72.5 (49.5–98.0)	75.6 (61.2–98.0)	69.3 (44.4–98.6)	0.234
Readmission, n%	2 (1.7)	0 (0.0)	2 (3.0)	0.509

Notes: *Statistically significant.

Abbreviations: OT, operative time (excluding docking); EBL, estimated blood loss; SICU, Surgical Intensive Care Unit; CNY, Chinese Yuan; MN, metanephrine; NMN, nor-metanephrine.

Table 3 Patients with High Level of nor-Metanephrine (>650 Pg/Ml)

Variable	Total (n=82)	Robotic Group (n=41)	Laparoscopic Group (n=41)	p-value
Age, year	44.0 (32.0–57.0)	43.0 (32.0–55.0)	45.0 (32.0–60.0)	0.513
Gender, n%				0.654
Male	34 (41.5)	18 (43.9)	16 (39.0)
Female	48 (58.5)	23 (56.1)	25 (61.0)
BMI, kg/m^2	23.1 (20.3–25.3)	23.1 (21.8–24.4)	22.9 (20.3–25.4)	0.817
Hypertension, n%	61 (74.4)	34 (82.9)	27 (65.9)	0.077
Diabetes, n%	15 (18.3)	7 (17.1)	8 (19.5)	0.775
Smoking, n%	4 (4.9)	1 (2.4)	3 (7.3)	0.608
Alcohol, n%	2 (2.4)	0 (0.0)	2 (4.9)	0.474
ASA, n%				0.429
1–2	75 (91.5)	39 (95.1)	36 (87.8)
3–4	7 (8.5)	2 (4.9)	5 (12.2)
CCI, n%				0.594
0–1	64 (78.0)	33 (80.5)	31 (75.6)
≥2	18 (22.0)	8 (19.5)	10 (24.4)
Prior abdominal surgery, n%	10 (12.2)	5 (12.2)	5 (12.2)	1.000
Preoperative hemoglobin, g/L	129.0 (118.0–137.0)	130.0 (118.0–136.0)	128.0 (119.0–139.0)	0.926
Preoperative albumin, g/L	41.0 (39.0–43.0)	41.0 (39.0–43.0)	41.0 (38.0–42.0)	0.166
Metanephrine, pg/mL	112.7 (72.5–732.2)	168.3 (68.1–643.5)	95.5 (74.0–1072.0)	0.792
Nor-Metanephrine, pg/mL	2088.6 (1099.6–3717.3)	2067.2 (1076.1–3754.3)	2305.7 (1178.0–3224.6)	0.908
Tumor size, cm	6.0 (5.5–7.5)	6.0 (5.5–7.5)	6.0 (5.5–7.5)	0.888
Tumor Laterility, n%				0.075
Left	46 (56.1)	27 (65.9)	19 (46.3)
Right	36 (43.9)	14 (34.1)	22 (53.7)
Surgical Technique, n%				0.627
Transperitoneal	58 (70.7)	30 (73.2)	28 (68.3)
Retroperitoneal	24 (29.3)	11 (26.8)	13 (31.7)
Conversion to open	2 (2.4)	0 (0.0)	2 (4.9)	0.474
OT, min	210.0 (180.0–250.0)	200 (170.0–240.0)	220 (190.0–260.0)	0.024*
EBL, mL	100.0 (50.0–200.0)	50.0 (30.0–200.0)	150.0 (100.0–200.0)	0.009*
Intraoperative complications	14 (17.1)	6 (14.6)	8 (19.5)	0.557
Intraoperative transfusion, n%	28 (34.1)	16 (39.0)	12 (29.3)	0.352
Postoperative complications
Postoperative transfusion, n%	21 (25.6)	12 (29.3)	9 (22.0)	0.448
Postoperative transfer to SICU	11 (13.4)	4 (9.8)	7 (17.1)	0.331
Postoperative hospital stay, day	13.0 (8.0–21.0)	13.0 (8.0–18.0)	14.0 (10.0–23.0)	0.518
Surgical expense (CNY)	22809.8 (8005.0–38075.0)	38052.5 (36780.0–38615.0)	8005 (6690.0–8828.0)	<0.001*
Postoperative MN, pg/mL	31.4 (17.3–50.0)	30.8 (20.9–46.5)	34.7 (16.6–49.7)	0.861
Postoperative NMN, pg/mL	72.2 (50.1–99.5)	75.6 (59.6–99.5)	68.8 (49.5–94.6)	0.394
Readmission, n%	1 (1.2)	0 (0.0)	1 (2.4)	1.000

Notes: *Statistically significant.

Abbreviations: BMI, body mass index; ASA, American Society of Anesthesiologists score; CCI, Charlson comorbidity index; OT, operative time (excluding docking); EBL, estimated blood loss; SICU, Surgical Intensive Care Unit; CNY, Chinese Yuan; MN=metanephrine; NMN, nor-metanephrine.