Effect of different therapeutic strategies on the clinical outcome of asymptomatic intralobar pulmonary sequestration

Abstract OBJECTIVES Pulmonary sequestration is a rare congenital pulmonary malformation. The aim of this study was to explore the effect of different therapeutic strategies on the clinical outcome of asymptomatic intralobar pulmonary sequestration. METHODS We retrospectively reviewed the clinical data of 37 patients diagnosed with intralobar sequestration. All the patients were asymptomatic. Seventeen patients underwent video-assisted thoracoscopic surgery (VATS) once diagnosed and 20 patients chose to undergo observation. Of these 20 patients, 16 patients developed symptoms during the observation period and also underwent VATS; 4 patients never showed symptoms and did not have surgery. The 33 patients who had VATS were divided into 2 groups: group 1, patients who underwent VATS once diagnosed; group 2, patients who underwent VATS once symptoms appeared. Postoperative data and respiratory function data were compared between the 2 groups. RESULTS Twenty of the patients were men and 17 were women (mean age 37.05 ± 7.89 years). Results of a comparative analysis of the 2 groups indicated that patients in group 1 had better values for median estimated blood loss, median duration of chest tube insertion, postoperative hospital stay and postoperative hospital stay than those in group 2. Postoperative complications were reported in 1 patient in group 1 and in 3 patients in group 2. Meanwhile, the loss of lung function between group 1 and group 2 was statistically significant, which also suggested that patients benefited from surgery once diagnosed. CONCLUSIONS For asymptomatic intralobar sequestration, VATS could be effective and safe. The surgical intervention should be performed once the condition is diagnosed to avoid manifestations occurring and to preserve patients’ quality of life.

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Treatment of Intrathoracic Anastomotic Leak After Esophagectomy with the Sump Drainage Tube

10.21203/rs.3.rs-86693/v1 ◽

2020 ◽

Author(s):

Qifan Yin ◽

Shaohui Zhou ◽

Yongbin Song Song ◽

Xuejiao Xun Xun ◽

Nana Liu Liu ◽

...

Keyword(s):

Hospital Stay ◽

Anastomotic Leak ◽

Chest Tube ◽

Average Duration ◽

Average Length ◽

Postoperative Hospital Stay ◽

Drainage Tube ◽

Group 2 ◽

New Treatments ◽

Group 1

Abstract Background: Intrathoracic esophagogastric anastomotic leak is one of the deadliest complications after esophagectomy. In recent years, we have implemented new method for the treatment of intrathoracic esophagogastric anastomotic leak with the nasogastric placement of sump drainage tube through fistula into abscess cavity. The aim of this study is to compare the efficacy of the new method and conventional therapies for intrathoracic anastomotic leak after esophagectomy. Method: Esophagectomy and esophagogastric anastomotic procedures were performed in 875 patients at our institution from January 2008 to December 2019. Of these patients, 43(4.9%) patients developed intrathoracic anastomotic leaks postoperatively were enrolled into our study and their clinical data were retrospectively assessed. 20 (47%) patients from January 2008 to December 2012 received conventional treatments (group 1) known as the traditional ‘‘three-tube method’’, and 23 (53%) patients from January 2013 to December 2019 received new treatments (group 2), consisted of conventional therapies and the nasogastric placement of sump drainage tube through fistula into abscess cavity. Results: The presence of intrathoracic anastomotic leak was proven by contrast esophagography in 43 patients (4.9%). Among them, The average duration of chest tube was 47 days in group 1 and 28 days in group 2. The average length of leak treatment was 52 days in group 1 and 35 days in group 2. The average length of postoperative hospital stay was 56 days in group 1 and 39 days in group 2,respectively. 7(35%) patients among 20 patients died from intrathoracic anastomotic leak in group 1;and 3(13%) patients among 23 patients died from intrathoracic anastomotic leak in group 2. Compared with the conventional treatments (group 1), The average duration of chest tube was significantly decreased in the new treatments (group 2) (P < 0.01), as well as the length of leak treatment (P < 0.05) and the length of postoperative hospital stay (P < 0.01). However, there was no significant difference in the mortality rate (P=0.148 > 0.05).Conclusion: In conclusion, Our results showed this method of the nasogastric placement of sump drainage tube through fistula appears to be an safe, effective, technically feasible treatment option for intrathoracic esophagogastric anastomotic leak. The efficacy and feasibility could be further investigated with a well-designed and large-scale RCT research.

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Treatment of intrathoracic anastomotic leak after esophagectomy with the sump drainage tube

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01429-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Qifan Yin ◽

Shaohui Zhou ◽

Yongbin Song ◽

Xuejiao Xun ◽

Nana Liu ◽

...

Keyword(s):

Hospital Stay ◽

Anastomotic Leak ◽

Chest Tube ◽

Average Duration ◽

Average Length ◽

Postoperative Hospital Stay ◽

Drainage Tube ◽

Group 2 ◽

New Treatments ◽

Group 1

Abstract Background Intrathoracic esophagogastric anastomotic leak is one of the deadliest complications after esophagectomy. In recent years, we have implemented new method for the treatment of intrathoracic esophagogastric anastomotic leak with the nasogastric placement of sump drainage tube through fistula into abscess cavity. The aim of this study is to compare the efficacy of the new method and conventional therapies for intrathoracic anastomotic leak after esophagectomy. Method Esophagectomy and esophagogastric anastomotic procedures were performed in 875 patients at our institution from January 2008 to December 2019. Of these patients, 43(4.9%) patients developed intrathoracic anastomotic leaks postoperatively were enrolled into our study and their clinical data were retrospectively assessed. 20 (47%) patients from January 2008 to December 2012 received conventional treatments (group 1) known as the traditional “three-tube method”, and 23 (53%) patients from January 2013 to December 2019 received new treatments (group 2), consisted of conventional therapies and the nasogastric placement of sump drainage tube through fistula into abscess cavity. Results The presence of intrathoracic anastomotic leak was proven by contrast esophagography in 43 patients (4.9%). Among them, The average duration of chest tube was 47 days in group 1 and 28 days in group 2. The average length of leak treatment was 52 days in group 1 and 35 days in group 2. The average length of postoperative hospital stay was 56 days in group 1 and 39 days in group 2, respectively. 7(35%) patients among 20 patients died from intrathoracic anastomotic leak in group 1; and 3(13%) patients among 23 patients died from intrathoracic anastomotic leak in group 2. Compared with the conventional treatments (group 1), The average duration of chest tube was significantly decreased in the new treatments (group 2) (P < 0.01), as well as the length of leak treatment (P < 0.05) and the length of postoperative hospital stay (P < 0.01). However, there was no significant difference in the mortality rate (P = 0.148 > 0.05). Conclusion In conclusion, Our results showed this method of the nasogastric placement of sump drainage tube through fistula appears to be an safe, effective, technically feasible treatment option for intrathoracic esophagogastric anastomotic leak. The efficacy and feasibility could be further investigated with a well-designed and large-scale RCT research.

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The retrospective study of perioperative application of dexamethasone and furosemide for postoperative anti-inflammation in patients undergoing percutaneous nephrolithotomy

International Urology and Nephrology ◽

10.1007/s11255-020-02718-1 ◽

2021 ◽

Author(s):

Taiguo Qi ◽

Xia Qi ◽

Xiude Chen ◽

Xunbo Jin

Keyword(s):

Clinical Outcome ◽

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Inflammatory Markers ◽

Serum Levels ◽

Postoperative Hospital Stay ◽

Lower Serum ◽

Combined Application ◽

Furosemide Administration ◽

Anti Inflammation

Abstract Objectives To investigate whether the perioperatively combined application of dexamethasone and furosemide could alleviate the inflammation in patients undergoing percutaneous nephrolithotomy (PCNL). Patients and methods 147 patients undergoing PCNL between November 2018 and October 2019 were enrolled in the study. 77 patients accepted a single dose of dexamethasone and furosemide administration (EXP group, n = 77), and 70 patients did not (CON group, n = 70). Demographic and perioperative data, inflammatory markers including interleukin-6 (IL-6) and procalcitonin (PCT), and clinical outcomes were compared between the two groups. Results Compared with the CON group, the incidence rate of urosepsis of the EXP group were significantly lower (11.69% vs. 24.29%, p = 0.046). 3 patients developed severe urosepsis in the EXP group, while 5 patients developed severe urosepsis in the CON group. Compared with those in the CON group, the patients with postoperative urosepsis in the EXP group showed lower serum levels of IL-6 at postoperative hour two (p = 0.045) and at postoperative day one (p = 0.031) and lower serum levels of PCT at postoperative day one (p = 0.015). There was a better clinical outcome of a shorter postoperative hospital stay (p = 0.015) in patients with postoperative urosepsis in the EXP group than in those in the CON group. Conclusion The perioperatively combined application of dexamethasone and furosemide was beneficial for alleviating postoperative inflammatory reaction and caused a better clinical outcome of a shorter postoperative hospital stay.

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Efficacy of Probiotic Saccharomyces boulardii as an Adjuvant Therapy in Acute Childhood Diarrhoea

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v36i3.15539 ◽

2017 ◽

Vol 36 (3) ◽

pp. 250-255 ◽

Cited By ~ 5

Author(s):

Dillip Kumar Dash ◽

Mrutunjaya Dash ◽

M.D. Mohanty ◽

Naresh Acharya

Keyword(s):

Hospital Stay ◽

Tertiary Care ◽

Acute Diarrhoea ◽

Oral Rehydration Therapy ◽

Saccharomyces Boulardii ◽

Care Hospital ◽

Oral Rehydration ◽

Group 2 ◽

A Prospective Study ◽

Group 1

Introduction: Administration of S. boulardii in addition to rehydration therapy in diarrhea found to be beneficial in many aspects owing to a variety of causes and importantly it is was not associated with any adverse effects.Material and Methods: We conducted a prospective study of children suffering from acute diarrhoea, at a private tertiary care hospital. Children were divided into 2 groups randomly as per odd(Group 1 ) and even (Group 2) bed allotted in indoor at the time of admission: Group 1 included children on oral rehydration therapy (ORT) + Zinc + Saccharomyces boulardii (Probiotic 5 billion CFU twice daily) and Group 2 comprised of children on ORT+ Zinc. Our objective was to systematically review data on the effect of S. boulardii on acute childhood diarrhoea.Results: Out of a total of 126 children less than 2 years, 2-6 years and 6-14 years were 72 (57.14%), 42(33.33%) and 12(09.52%) respectively. The duration of diarrhoea in Group 1 was 26.31 hours and Group 2 was 47.81 hours (p<0.01). The frequency of diarrhoea showed improvement within 24 and 72 hours in Group 1 and Group 2 respectively (p<0.01).Similarly, the mean duration of hospital stay was 2.68 days in Group 1 and 4.8 days in Group 2.The treatment cost was INR 850 and INR 1650 while social cost was INR 1250 and 2600 in Group 1 and 2 respectively.Conclusion:This study shows that S. boulardii reduced the duration, frequency and hospital stay of diarrhoea thereby reducing the treatment and social costs.J Nepal Paediatr Soc 2016;36(3):250-255

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Defining The Learning Curve of Single-Port Inflatable Mediastinoscopy With Simultaneous Laparoscopic-Assisted Surgery For Radical Esophagectomy

10.21203/rs.3.rs-643095/v1 ◽

2021 ◽

Author(s):

Jinpeng Shi ◽

Xiaojian Li ◽

Tianchi Wu ◽

Xiangwen Wu ◽

Xiaojin Wang ◽

...

Keyword(s):

Learning Curve ◽

Single Port ◽

Thoracoscopic Surgery ◽

Surgical Team ◽

Radical Esophagectomy ◽

Extensive Experience ◽

Estimated Blood Loss ◽

Group 2 ◽

Laparoscopic Assisted ◽

Group 1

Abstract Background Single-port inflatable mediastinoscopy with simultaneous laparoscopic-assisted surgery for radical esophagectomy is a promising surgical method with high technical requirements and needs team cooperation. Therefore, it is necessary to define a learning curve to guide personnel training and improve the safety of these surgical techniques.Method This study prospectively analyzed the data of 79 consecutive patients, who underwent the surgery in the Fifth Affiliated Hospital of Sun Yat-sen University from October 2016 to May 2018. All of these patients were treated by the same surgical team with extensive experience in thoracotomy, laparotomy, thoracoscopic surgery and laparoscopic surgery. The learning curve was analyzed by cumulative summation (CUSUM) analysis, with the assessment of operative time, estimated blood loss, and postoperative complications.Result By analyzing these data, The scatter diagram of every measure showing a declining situation. The learning curve decreased beginning at 25th operation. All patients were chronologically divided into two groups, the group 1(the first 25 patients) and the group 2 (the last 54 patients). The median estimated blood loss of group 2 was lower than group 1(200 vs 100ml, p<0.05). No other clinic or pathologic characteristics were observed as significantly different.Conclusion For a surgical team with extensive experience in thoracotomy, laparotomy, thoracoscopic surgery and laparoscopic surgery, 25 cases are needed before becoming proficient in this surgery.

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Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial

Acta Endocrinologica ◽

10.1530/eje-09-0908 ◽

2010 ◽

Vol 162 (4) ◽

pp. 661-666 ◽

Cited By ~ 66

Author(s):

Zhi-gang Mao ◽

Yong-hong Zhu ◽

Hai-liang Tang ◽

Dao-yuan Wang ◽

Jing Zhou ◽

...

Keyword(s):

Hospital Stay ◽

Transsphenoidal Surgery ◽

Randomised Trial ◽

Preoperative Treatment ◽

Surgical Morbidity ◽

Randomised Study ◽

Surgical Cure ◽

Group 2 ◽

Cure Rates ◽

Group 1

ObjectiveTo investigate whether 4-month preoperative lanreotide treatment would improve the surgical cure rate of newly diagnosed acromegalic patients with macroadenomas.DesignA prospective, randomised study.MethodsAfter a baseline evaluation, patients were randomly assigned to 4-month preoperative treatment with lanreotide (starting with 30 mg/2 weeks i.m. and increasing to 30 mg/week i.m. at week 8 if mean GH >2.5 μg/l on GH day curves; pretreatment group, Group 1) or to transsphenoidal surgery (direct surgery group, Group 2). Cure was evaluated 4 months postoperatively primarily by fasting IGF1 less than or equal to age-adjusted upper limit of normal.ResultsA pool of 108 patients was randomly divided into two groups. Five patients in each group were lost to follow-up during the study period, so 49 patients in each group were analysed. At baseline, no difference was observed between the two groups. Cure was established in 24 of 49 (49.0%, 95% confidence interval (CI), 35.0–63.0%) pretreated patients (Group 1) versus 9 of 49 (18.4%, 95% CI, 7.6–29.2%) direct surgery patients (Group 2;P=0.001). Surgical morbidity was recorded in 12 patients (12.2%) and was similar in Group 1 and 2 patients (14.3 and 10.2% respectively;P=0.538). The postoperative hospital stay was similar between groups: being 4.5±1.6 days in Group 1 vs 4.8±1.9 days in Group 2 (P=0.328).ConclusionsPretreatment with lanreotide before transsphenoidal surgery improves surgical cure rates in patients with GH-secreting pituitary macroadenomas. Pretreatment does not affect surgical complications or duration of hospital stay (ClinicalTrials.gov number, NCT00993356).

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Comparative study of laparoscopic hernia repair versus open hernia repair

Journal of Nobel Medical College ◽

10.3126/jonmc.v7i2.22303 ◽

2018 ◽

Vol 7 (2) ◽

pp. 30-34

Author(s):

Rohit Prasad Yadav ◽

Dipendra Thakur ◽

Bashu Dev Baskota ◽

Amit Kumar Shah ◽

Kaushal Samsher Thapa ◽

...

Keyword(s):

Hernia Repair ◽

Comparative Study ◽

Hospital Stay ◽

Laparoscopic Hernia Repair ◽

Fatty Tissue ◽

Duration Of Surgery ◽

Group 2 ◽

Lower Pain Score ◽

Open Hernia Repair ◽

Group 1

Background: Hernia is the abnormal exit of an organ or fatty tissue, such as the bowel, through the weak wall of the cavity in which it normally resides. Repair of inguinal hernia is common surgical procedures. This study aims to compare between laparoscopic and open hernia repair. Method: Study is non randomized comparative study. Study includes 76 patients who had undergone surgery for hernioplasty. Among them 38 undergone laparoscopic hernioplasty and 38 undergone open hernioplasty from June 2016 to August 2018. Results: Mean hospital stay was 2.95 days in group 1 and 4.03 in group 2 .VAS was found to be 2.45 in group 1 and 5.71 in group 2 which is significantly low in group 1 patients with p<0.001. Duration of surgery is more in group 1 with mean duration of 94.08 minutes comparing to group 2 with mean duration of 43.55 minutes (with p<0.001). Conclusion: Laparoscopic hernia repair offers advantages over open repair in terms of less hospital stay and lower pain score for patient not contraindicated for general anesthesia and complicated hernia.

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PS01.218: MORBIDITY AND MORTALITY IN ELDERLY PATIENTS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.218 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 112-112

Author(s):

Jeroen Hol ◽

Joos Heisterkamp ◽

Barbara Langenhoff

Keyword(s):

Minimally Invasive ◽

Elderly Patients ◽

Hospital Stay ◽

Minimally Invasive Esophagectomy ◽

Length Of Hospital Stay ◽

Morbidity And Mortality ◽

Tumor Type ◽

Invasive Esophagectomy ◽

Group 2 ◽

Group 1

Abstract Background Elderly patients undergoing gastrointestinal surgery are at higher risk for postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates back from the time before minimally invasive techniques were implemented. Methods Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older was compared to the cohort of patients aged 71 to 75 years old. Results From a consecutive series of in total 187 patients two cohorts were retrieved: 19 patients 76 years or older (group 1) were compared to 41 patients 71 to 75 years old (group 2). Median age was 77 years (76–83) in group 1 and 72 years (71–75) in group 2 (P < 0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiaton, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The percentage of anastomotic leakage was 21.2% in group 1 and 14.6% in group 2. Mortality was 10.5% and 4.9% respectively. Conclusion No difference was seen in morbidity and mortality after MIE comparing the eldest old to younger old patients. Therefore, patient selection should not be based on calendar age alone. Disclosure All authors have declared no conflicts of interest.

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Comparable Outcomes with or without Routine Granulocyte Growth Factor Support Following Autologous Peripheral Blood Stem Cell Transplantation (PBSCT): A Single Center Experience.

Blood ◽

10.1182/blood.v114.22.1178.1178 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1178-1178

Author(s):

Harris V. Naina ◽

Shaji Kumar ◽

Shekhar Bitla ◽

Jeffrey Winters ◽

William Hogan ◽

...

Keyword(s):

Stem Cell ◽

Growth Factor ◽

Stem Cell Transplantation ◽

Hospital Stay ◽

Cell Transplantation ◽

Ambulatory Care Setting ◽

Group 2 ◽

Febrile Episodes ◽

Neutrophil Engraftment ◽

Group 1

Abstract Abstract 1178 Poster Board I-200 Background: High-dose chemotherapy with autologous peripheral blood stem cell transplantation (PBSCT) has been shown to be of value in selected patients with malignant lymphoma and multiple myeloma (MM). Both granulocyte macrophage colony stimulating factor (GMCSF) and granulocyte colony stimulating factor (GCSF) are widely used following stem cell transplantation to support accelerated myeloid recovery and potentially shorten hospital stay. In the recent years, PBSCT is increasingly done in an ambulatory care setting and it is not clear if routine growth factor use has any potential benefit. We undertook this study to compare engraftment kinetics, incidence of febrile episodes, hospitalization duration and other outcomes among transplants done with or without growth factor support Patients and Methods: We included adult patients undergoing PBSCT for myeloma and lymphoma between May 2007 and June 2009 in an ambulatory care setting. Prior to April 2008 (Group-1) all patients received GMCSF 500 mcg/ day starting on day 6 routinely. Since April 2008, there was a shift in clinical practice and routine use of GMCSF was discontinued due to lack of clear evidence regarding benefit. Patients transplanted between April 2008 and June 2009 did not routinely receive GMCSF (Group-2). Typical conditioning regimen for lymphoma was BEAM (BCNU, Etoposide, Cytosine Arabinose, Melphalan) and for multiple myeloma was melphalan 200mg/m2. Patients' demographics details, indication for PBSCT, duration of neutropenic fever, hospital stay, and neutrophil and platelet engraftment were collected from electronic medical records. Neutrophil engraftment is defined as the first day of 2 consecutive days when ANC was > 0.5 × 109/L and platelet engraftment is defined as first of 7 consecutive days on which patient's unsupported platelet count was greater than 20× 109/L. Results: A total of 309 were included in this study, 126 (40%) patients in group-1 (69 with MM, 57 with lymphoma) and 183 (60%) in group-2 (100 with MM, 83 with lymphoma). In group-1, 73 (58%) and in group-2 130 (71%) were male patients. Median age was 59 (29-74) years in group 1 and 58 (24-76) years in group-2. Patients in group 1 received a median of 3.65 (1.1-8.7) versus 4.37 (1.1-9.54) CD34+ x106/kg in group 2 (P =0.005). Median time to neutrophil engraftment was 12 (95% CI 12, 12) for group-1 and 14 (95% CI; 13-14) for group-2 (Kaplan Meier analysis; log rank P < 0.0001). Median estimated time to platelet engraftment was 14 days (95% CI; 13, 15) for group 1 and 13 days (95% CI; 13-13) for group 2 (Kaplan Meier analysis; log rank P 0.007). In group-1 98 (78%) patients developed febrile episodes compared to 117(64%) in group-2 (P = 0.009). Median duration of fever was 2 days (range, 1-8) in group-1 compared to 1 day (range, 1-8) in group-2 (P = 0.0003). The median (range) duration of hospital stay was 7 (1-40) days for group-1 compared to 8 (2-56) days for group-2 (P=NS). There was no significant difference in mortality between these two groups. Conclusion: Routine use of granulocyte growth factors is associated with a shorter time to neutrophil engraftment, but associated with a delay in platelet engraftment. The longer time to neutrophil engraftment without growth factor use does not translate into any increase in frequency of febrile episodes. On the contrary, higher number of febrile days is seen with use of growth factors, likely explained on the basis of drug fever. No difference in the frequency of engraftment syndrome or treatment related mortality was seen. Disclosures: No relevant conflicts of interest to declare.

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Adrenal Incidentalomas: Should We Operate on Small Tumors in the Era of Laparoscopy?

International Journal of Endocrinology ◽

10.1155/2014/658483 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Michał Pędziwiatr ◽

Michał Natkaniec ◽

Mikhail Kisialeuski ◽

Piotr Major ◽

Maciej Matłok ◽

...

Keyword(s):

Surgical Treatment ◽

Operation Time ◽

Adrenal Tumors ◽

Estimated Blood Loss ◽

Important Argument ◽

Risk Of Malignancy ◽

Potentially Malignant ◽

Group 2 ◽

Histopathological Results ◽

Group 1

Tumor size smaller than 4 cm as an indication for surgical treatment of incidentaloma is still a subject of discussion. Our aim was the estimation of the incidence of malignancy and analysis of treatment outcomes in patients with incidentaloma smaller than 4 cm in comparison to bigger lesions. 132 patients who underwent laparoscopic adrenalectomy for nonsecreting tumors were divided into two groups: group 1 (55 pts., size < = 40 mm) and group 2 (77 pts., size > 40 mm). Operation parameters and histopathological results were analyzed. No differences in group characteristics, mean operation time, and estimated blood loss were noted. Complications in groups 1 and 2 occurred in 3.6% and 5.2% of patients, respectively (P=0.67). Malignancy in groups 1 and 2 was present in 1 and 6 patients, respectively (P=0.13). Potentially malignant lesions were identified in 4 patients in group 1 and 4 patients in group 2 (P=0.39). The results do not allow for straightforward recommendations for surgical treatment of smaller adrenal tumors. The safety of laparoscopy and minimal, but impossible to omit, risk of malignancy support decisions for surgery. On the other hand, the risk of malignancy in smaller adrenal tumors is lower than surgical complications, which provides an important argument against surgery.

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