Predict Factors Related With Conversion To Open Surgery Of Retroperitoneoscopic Adrenalectomy For Pheochromocytoma

Objective:During the period of September 2006 to September 2016,a total of 94 retroperitoneoscopic adrenalectomies for Pheochromocytoma were performed by 3 surgeons at a single center,and 15 cases required conversion.The purpose of this study was to investigate the predict factors related with conversion to open procedure in retroperitoneoscopic adrenalectomy for pheochromocytoma by analyzing the clinical data of all patients before surgery.Methods:All the 94 cases were suspicious of pheochromocytoma preoperatively,we carried out preoperative preparation to all the patients,all cases were confirmed as pheochromocytoma by pathological examination.53 cases were males,other 41 cases were females,average age was 41.4±14.4 years(10-68yr).There were 42 cases' tumors on the left side,the other 52 cases on the right side.27 cases(28.7%)were complicated with diabetes.10cases(10.6%)combined with heart disease(arrhythmia,ventricular hypertrophy,heart failure,etc.).60 cases(63.8%)werecomplicated with hypertension.In accordance with the body mass index(BMI)classification published by China,which was appropriate for Chinese people,all the cases was separated into three groups(BMI?28 kg/m2: 31 cases,24~27.9 kg/m2: 35 cases,<24 kg/m2: 28 cases).The tumor size according to the imaging examination was divided into three groups(tumor size < 3cm: 33 cases,3 ~ 6 cm: 39 cases,?6 cm: 22 cases).Computerized tomography(CT)scans in 35 cases showed that tumors' borders were ill-defined or compression on the surrounding tissues.Preoperative preparation time also was divided into three groups(<2 weeks: 24 cases,2~4 weeks: 27 cases,? 4 weeks: 43 cases).Finally,a total of 15 retroperitoneoscopic adrenalectomies for Pheochromocytoma required conversion,the rest 79 cases were accomplished successfully.We divided the cases into two groups:converted group and unconverted group.Univariate analysis and multivariate analysis were used to evaluate the factors including age,sex,BMI,diabetes status,heart disease,hypertension status,tumor location,tumor size,tumor border over CT scan,preoperative preparation time,surgeon.Using SPSS19.0 statistical software for statistical analysis,univariate analysis was achieved through c2 test.The significant risk factors in the univariate analysis were analyzed in multivariate Logistic regression analysis.P < 0.05 was considered significant statistically.Results:The rate of conversion to open procedure in retroperitoneoscopic adrenalectomy for pheochromocytoma was 15.9%;the results of univariate analysis for converted group and unconverted group showed that diabetes(P = 0.009),hypertension(P = 0.045),BMI(P< 0.001),tumor size(P < 0.001),tumor border over CT scan(P =0.002),preoperative preparation time(P = 0.030),respectively,were significantly correlated with conversion to an open procedure in retroperitoneoscopic adrenalectomy for pheochromocytoma,the significant factors in the univariate analysis were moved into multivariate Logistic regression analysis and showed that diabetes(P = 0.029,OR = 9.204),hypertension(P = 0.015,OR = 24.290),BMI?28 kg/m2(P = 0.035,OR = 9.225),tumor size ?6cm(P = 0.033,OR = 19.969)were significantly correlated with conversion to open procedure in retroperitoneoscopic adrenalectomy for pheochromocytoma.Conclusions:Tumor size ?6cm,obesity,hypertension and diabetes are the major predict factors related with Conversion to open surgery of Retroperitoneoscopic Adrenalectomy for Pheochromocytoma.