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Published online: 2019-06-10
Submitted: 2019-03-11
Accepted: 2019-03-29
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Impact of laparoscopic adrenalectomy on renal function. Results of a prospective randomized clinical trial.

Tomasz Kozlowski, Alicja Rydzewska-Rosolowska, Janusz Mysliwiec, Barbara Choromanska, Piotr Wojskowicz, Jacek Dadan, Marta Lukaszewicz-Zajac, Barbara Mroczko, Piotr Mysliwiec
DOI: 10.5603/EP.a2019.0029
·
Pubmed: 31274187

open access

Ahead of print
Original papers
Published online: 2019-06-10
Submitted: 2019-03-11
Accepted: 2019-03-29

Abstract

Introduction. Laparoscopic adrenalectomy is the gold standard management of benign adrenal masses and isolated metastases to adrenal gland. Two techniques of endoscopic adrenalectomy: lateral transperitoneal approach (LTA) and posterior retroperitonel approach (PRA) seem to be equally safe and effective. Recent studies suggest advantages of PRA over LTA in terms of lower intensity of postoperative pain, shorter hospital stay, faster recovery and lower early morbidity. However, PRA involves high insufflation pressure of CO2 within a limited retroperitoneal space. The aim of our study was to prospectively assess the effect of LTA versus PRA laparoscopic adrenalectomies on renal function. Material and methods. We randomly assigned patients referred for unilateral adrenalectomy to either LTA (n=33) or PRA (n=44). The inclusion criteria were: hormonal activity and/or tumor diameter > 4 cm and/or suspicion of metastasis to adrenal gland. The exclusion criteria comprised: tumors > 8 cm, results of imaging studies suggesting primary invasive malignancy and refusal to undergo randomization. The patients were prospectively followed for a minimum of 6 months. Serum creatinine, cystatin C and urinary neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively and at postoperative days: 1, 7 and 30. Results. We found increased concentrations of urinary NGAL at day 1 following laparoscopic adrenalectomy using PRA, as compared to LTA. Patients undergoing right-sided PRA had increased creatinine concentrations, as compared to left-sided PRA. Patients with aldosterone-producing adenoma had decreased preoperative eGFR as compared to subjects with non-functioning incidentaloma. NGAL increased significantly in this group postoperatively. All the disturbances normalized within one month postoperatively. Conclusions. Renal function impairment after PRA may result from compression of inferior vena cava by high retroperitoneal pressure during right-sided adrenalectomy. Despite transient character of observed abnormalities, we suggest that patients with high risk of acute kidney injury may benefit from alternative technique of adrenalectomy using LTA.

Abstract

Introduction. Laparoscopic adrenalectomy is the gold standard management of benign adrenal masses and isolated metastases to adrenal gland. Two techniques of endoscopic adrenalectomy: lateral transperitoneal approach (LTA) and posterior retroperitonel approach (PRA) seem to be equally safe and effective. Recent studies suggest advantages of PRA over LTA in terms of lower intensity of postoperative pain, shorter hospital stay, faster recovery and lower early morbidity. However, PRA involves high insufflation pressure of CO2 within a limited retroperitoneal space. The aim of our study was to prospectively assess the effect of LTA versus PRA laparoscopic adrenalectomies on renal function. Material and methods. We randomly assigned patients referred for unilateral adrenalectomy to either LTA (n=33) or PRA (n=44). The inclusion criteria were: hormonal activity and/or tumor diameter > 4 cm and/or suspicion of metastasis to adrenal gland. The exclusion criteria comprised: tumors > 8 cm, results of imaging studies suggesting primary invasive malignancy and refusal to undergo randomization. The patients were prospectively followed for a minimum of 6 months. Serum creatinine, cystatin C and urinary neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively and at postoperative days: 1, 7 and 30. Results. We found increased concentrations of urinary NGAL at day 1 following laparoscopic adrenalectomy using PRA, as compared to LTA. Patients undergoing right-sided PRA had increased creatinine concentrations, as compared to left-sided PRA. Patients with aldosterone-producing adenoma had decreased preoperative eGFR as compared to subjects with non-functioning incidentaloma. NGAL increased significantly in this group postoperatively. All the disturbances normalized within one month postoperatively. Conclusions. Renal function impairment after PRA may result from compression of inferior vena cava by high retroperitoneal pressure during right-sided adrenalectomy. Despite transient character of observed abnormalities, we suggest that patients with high risk of acute kidney injury may benefit from alternative technique of adrenalectomy using LTA.

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Keywords

adrenalectomy, acute kidney injury, NGAL, creatinine, cystatin C

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About this article
Title

Impact of laparoscopic adrenalectomy on renal function. Results of a prospective randomized clinical trial.

Journal

Endokrynologia Polska

Issue

Ahead of print

Published online

2019-06-10

DOI

10.5603/EP.a2019.0029

Pubmed

31274187

Keywords

adrenalectomy
acute kidney injury
NGAL
creatinine
cystatin C

Authors

Tomasz Kozlowski
Alicja Rydzewska-Rosolowska
Janusz Mysliwiec
Barbara Choromanska
Piotr Wojskowicz
Jacek Dadan
Marta Lukaszewicz-Zajac
Barbara Mroczko
Piotr Mysliwiec

References (37)
  1. Mansmann G, Lau J, Balk E, et al. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev. 2004; 25(2): 309–340.
  2. Szeliga J, Sondka Z, Jackowski M, et al. NOD2/CARD15 polymorphism in patients with rectal cancer. Med Sci Monit. 2008; 14(9): CR480–CR484.
  3. Kuklinski A, Kamocki Z, Koda M, et al. IGF-IR in patients with advanced colorectal cancer in correlation with certain clinico-morphological factors: Initial report. Oncol Lett. 2011; 2(6): 1155–1159.
  4. Swiglo BA, Murad MH, Schünemann HJ, et al. A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab. 2008; 93(3): 666–673.
  5. Myśliwiec J, Zukowski L, Grodzka A, et al. Problems in diagnostics of primary aldosteronism - analysis of the own data. Endokrynol Pol. 2010; 61(1): 2–5.
  6. Myśliwiec J, Siewko K, Zukowski L, et al. Pheochromocytoma — analysis of 15 consecutive cases from one centre. Endokrynol Pol. 2013; 64(3): 192–196.
  7. Myśliwiec J, Rudy A, Siewko K, et al. [Diagnostic difficulties in adrenal incidentaloma — analysis of 125 cases]. Endokrynol Pol. 2007; 58(5): 417–421.
  8. Szeliga J, Jackowski M. Minimally invasive procedures in severe acute pancreatitis treatment - assessment of benefits and possibilities of use. Wideochir Inne Tech Maloinwazyjne. 2014; 9(2): 170–178.
  9. Piątkowski J, Jackowski M, Szeliga J. Laparoscopic surgery of esophageal hiatus hernia - single center experience. Wideochir Inne Tech Maloinwazyjne. 2014; 9(1): 13–17.
  10. Tiberio GAM, Baiocchi GL, Arru L, et al. Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma. Surg Endosc. 2008; 22(6): 1435–1439.
  11. Lee CR, Walz MK, Park S, et al. A comparative study of the transperitoneal and posterior retroperitoneal approaches for laparoscopic adrenalectomy for adrenal tumors. Ann Surg Oncol. 2012; 19(8): 2629–2634.
  12. Nigri G, Rosman AS, Petrucciani N, et al. Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery. 2013; 153(1): 111–119.
  13. Barczyński M, Konturek A, Nowak W. Randomized clinical trial of posterior retroperitoneoscopic adrenalectomy versus lateral transperitoneal laparoscopic adrenalectomy with a 5-year follow-up. Ann Surg. 2014; 260(5): 740–7; discussion 747.
  14. Myśliwiec P, Marek-Safiejko M, Lukaszewicz J, et al. Videoscopic adrenalectomy — when does retroperitoneal seem better? Wideochir Inne Tech Maloinwazyjne. 2014; 9(2): 226–233.
  15. Marek-Safiejko M, Safiejko K, Łukaszewicz J, et al. A Comparison of Two Approaches to Laparoscopic Adrenalectomy: Lateral Transperitoneal Versus Posterior Retroperitoneal Approach. Adv Clin Exp Med. 2016; 25(5): 829–835.
  16. Yoshioka M, Nakajima Y, Miyamoto T, et al. Age-Dependent Progression of Renal Dysfunction After Adrenalectomy for Aldosterone-Producing Adenomas in Japan. J Endocr Soc. 2019; 3(3): 577–589.
  17. Onohara T, Takagi T, Yoshida K, et al. Assessment of postoperative renal function after adrenalectomy in patients with primary aldosteronism. Int J Urol. 2019; 26(2): 229–233.
  18. Utsumi T, Kamiya N, Kaga M, et al. Development of novel nomograms to predict renal functional outcomes after laparoscopic adrenalectomy in patients with primary aldosteronism. World J Urol. 2017; 35(10): 1577–1583.
  19. Major P, Matłok M, Pędziwiatr M, et al. Do we really need routine drainage after laparoscopic adrenalectomy and splenectomy? Wideochir Inne Tech Maloinwazyjne. 2012; 7(1): 33–39.
  20. Abella V, Scotece M, Conde J, et al. The potential of lipocalin-2/NGAL as biomarker for inflammatory and metabolic diseases. Biomarkers. 2015; 20(8): 565–571.
  21. Liebetrau C, Gaede L, Doerr O, et al. Neutrophil gelatinase-associated lipocalin (NGAL) for the early detection of contrast-induced nephropathy after percutaneous coronary intervention. Scand J Clin Lab Invest. 2014; 74(2): 81–88.
  22. Chapter 1: Definition and classification of CKD. Kidney Int Suppl. 2013; 3(1): 19–62.
  23. Natkaniec M, Pędziwiatr M, Wierdak M, et al. Laparoscopic adrenalectomy for pheochromocytoma is more difficult compared to other adrenal tumors. Wideochir Inne Tech Maloinwazyjne. 2015; 10(3): 466–471.
  24. Pędziwiatr M, Wierdak M, Ostachowski M, et al. Single center outcomes of laparoscopic transperitoneal lateral adrenalectomy — Lessons learned after 500 cases: A retrospective cohort study. Int J Surg. 2015; 20: 88–94.
  25. Çelik T, Altekin E, İşgüder R, et al. Evaluation of neutrophil gelatinase-associated lipocalin in pediatric patients with acute rotavirus gastroenteritis and dehydration. Ital J Pediatr. 2013; 39: 52.
  26. Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem. 1992; 38(10): 1933–1953.
  27. Watanabe S, Okura T, Kurata M, et al. Valsartan reduces serum cystatin C and the renal vascular resistance in patients with essential hypertension. Clin Exp Hypertens. 2006; 28(5): 451–461.
  28. Salgado JV, Souza FL, Salgado BJ. How to understand the association between cystatin C levels and cardiovascular disease: Imbalance, counterbalance, or consequence? J Cardiol. 2013; 62(6): 331–335.
  29. Kim IlY, Park IS, Kim MJ, et al. Change in kidney function after unilateral adrenalectomy in patients with primary aldosteronism: identification of risk factors for decreased kidney function. Int Urol Nephrol. 2018; 50(10): 1887–1895.
  30. Kaga M, Utsumi T, Tanaka T, et al. Risk of New-Onset Dyslipidemia After Laparoscopic Adrenalectomy in Patients with Primary Aldosteronism. World J Surg. 2015; 39(12): 2935–2940.
  31. Choromańska B, Myśliwiec P, Dadan J, et al. The clinical significance of fatty acid binding proteins. Postępy Hig Med Dośw. 2011; 65: 759–763.
  32. Choromańska B, Myśliwiec P, Razak Hady H, et al. Metabolic Syndrome is Associated with Ceramide Accumulation in Visceral Adipose Tissue of Women with Morbid Obesity. Obesity (Silver Spring). 2019; 27(3): 444–453.
  33. Myśliwiec H, Baran A, Harasim-Symbor E, et al. Increase in circulating sphingosine-1-phosphate and decrease in ceramide levels in psoriatic patients. Arch Dermatol Res. 2017; 309(2): 79–86.
  34. Choromańska K, Choromańska B, Dąbrowska E, et al. Saliva of obese patients — is it different? Postepy Hig Med Dosw (Online). 2015; 69: 1190–1195.
  35. Donderski R, Stróżecki P, Sulikowska B, et al. Aldosterone antagonist therapy and its relationship with inflammation, fibrosis, thrombosis, mineral-bone disorder and cardiovascular complications in peritoneal dialysis (PD) patients. Int Urol Nephrol. 2017; 49(10): 1867–1873.
  36. Willenberg HS, Ansurudeen I, Schebesta K, et al. The endothelium secretes interleukin-6 (IL-6) and induces IL-6 and aldosterone generation by adrenocortical cells. Exp Clin Endocrinol Diabetes. 2008; 116(Suppl 1): S70–S74.
  37. Mysliwiec J, Zbucki R, Winnicka MM, et al. A crucial role of interleukin-6 in the pathogenesis of thyrotoxicosis-related disturbances of bone turnover in mice. Horm Metab Res. 2007; 39(12): 884–888.

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