Login to Access Video or Poster Abstract: MP37-07
Sources of Funding: NSFC, 81460389, to Gongxian Wang;_x000D_ Robotic Research Grant (Intuitive Surgical Operations, Inc), Robotic Adrenalectomy: Preoperative Evaluation of Surgical Risk, Standardization of Retroperitoneal_x000D_ Approach and Outcome Comparison with Transperitoneal Approach, to Gongxian Wang_x000D_

Introduction

Treatment planning for adrenal tumors depends on a variety of qualitative and quantitative data, including tumor nature and anatomy, as well as the experience of the operating surgeon. Here, we have developed and propose a scoring system for adrenal masses designated as the A.D.R.E.N.A.L Score, to quantify the nature and anatomical characteristics of adrenal masses based on endocrinological assessment, computerized tomography and patient habitus.

Methods

The A.D.R.E.N.A.L score consists of 7 components including (A)ldosterone/cortisol/catecholamine secretion or suspicion of malignancy based on endocrinological and radiological study, (D)imension (tumor size as the maximal diameter), (R)elationship to adjacent organs, (E)nhancement on computerized tomography, (N)earness of the tumor to major vessels, (A)dipose (patient habitus as body mass index), and a combination of two (L)ocation descriptors [anterior (a) or posterior (p), left (L) or right (R)]. The A.D.R.E.N.A.L score was applied to 345 cases, including 212 laparoscopic retroperitoneal adrenalectomy cases and 105 robotic retroperitoneal adrenalectomy cases and 28 robotic transperitoneal adrenalectomy cases.

Results

For all three series, the A.D.R.E.N.A.L score accurately classified the complexity of cases in the above three series as evidenced by the positive correlation between the A.D.R.E.N.A.L score and surgical outcomes including the operative time and estimated blood loss, while BMI or tumor size did not as independent risk factor.

Conclusions

Standardized evaluation of an adrenal tumor is essential for individualized patient preparation, surgical planning and postoperative care which translate to patient safety and cost-effectiveness. The A.D.R.E.N.A.L score is a reproducible classification system based on endocrinological, oncological and anatomical characteristics of adrenal masses. This novel scoring system of adrenal masses may provide a common reference for the decision making of both endocrinologist and urologist, assessment of the surgical risks, patient safety-guided designing of adrenalectomy training programs, and stratified analysis and comparisons of adrenal surgeries within a single or among multiple institutions.

Funding

NSFC, 81460389, to Gongxian Wang;_x000D_ Robotic Research Grant (Intuitive Surgical Operations, Inc), Robotic Adrenalectomy: Preoperative Evaluation of Surgical Risk, Standardization of Retroperitoneal_x000D_ Approach and Outcome Comparison with Transperitoneal Approach, to Gongxian Wang_x000D_