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. 2022 Sep;36(9):6507-6515.
doi: 10.1007/s00464-021-09005-9. Epub 2022 Jan 13.

Predicting surgical outcome in posterior retroperitoneoscopic adrenalectomy with the aid of a preoperative nomogram

Allon van Uitert  1 , Elle C J van de Wiel  2 , Jordache Ramjith  3 , Jaap Deinum  4 , Henri J L M Timmers  4 , J Alfred Witjes  2 , Leo J Schultze Kool  5 , Johan F Langenhuijsen  2
Affiliations

Predicting surgical outcome in posterior retroperitoneoscopic adrenalectomy with the aid of a preoperative nomogram

Allon van Uitert et al. Surg Endosc. 2022 Sep.

Abstract

Background: Posterior retroperitoneoscopic adrenalectomy (PRA) has several advantages over transperitoneal laparoscopic adrenalectomy (TLA) regarding operative time, blood loss, postoperative pain, and recovery. However, it can be a technically challenging procedure. To improve patient selection for PRA, we developed a preoperative nomogram to predict operative time.

Methods: All consecutive patients with tumors of ≤ 7 cm and a body mass index (BMI) of < 35 kg/m2 undergoing unilateral PRA between February 2011 and March 2020 were included in the study. The primary outcome was operative time as surrogate endpoint for surgical complexity. Using ten patient variables, an optimal prediction model was created, with a best subsets regression analysis to find the best one-variable up to the best seven-variable model.

Results: In total 215 patients were included, with a mean age of 52 years and mean tumor size of 2.4 cm. After best subsets regression analysis, a four-variable nomogram was selected and calibrated. This model included sex, pheochromocytoma, BMI, and perinephric fat, which were all individually significant predictors. This model showed an ideal balance between predictive power and applicability, with an R2 of 38.6.

Conclusions: A four-variable nomogram was developed to predict operative time in PRA, which can aid the surgeon to preoperatively identify suitable patients for PRA. If the nomogram predicts longer operative time and therefore a more complex operation, TLA should be considered as an alternative approach since it provides a larger working space. Also, the nomogram can be used for training purposes to select patients with favorable characteristics when learning this surgical approach.

Keywords: Adrenalectomy; Laparoscopy; Nomogram; Operative time; Predictive model; Retroperitoneoscopic.

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Conflict of interest statement

Authors Allon van Uitert, Elle C. J. van de Wiel, Jordache Ramjith, Jaap Deinum, Henri J. L. M. Timmers, J. Alfred Witjes, Leo J. Schultze, and Johan F. Langenhuijsen have no conflict of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Pictures illustrating the radiological measurements on abdominal CT. A tumor size. B vertical distance tumor. C position of the kidney. D skin distance. E adrenal depth. F perinephric fat
Fig. 2
Fig. 2
Individual weight of the four variables in the final model
Fig. 3
Fig. 3
Application of the nomogram
Fig. 4
Fig. 4
Calibration curves compare predicted and observed log duration. The blue line shows that the slope for the relationship between the predicted log duration and the observed log duration was 1.00 (95% CI 0.82–1.18) and the intercept was 0 (95% CI − 0.75 to 0.75)
See this image and copyright information in PMC

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