EVALUATION OF THE COMPLEXITY OF ADRENAL - SPARING SURGERY IN PATIENTS WITH ADRENAL TUMORS - VSLP SCALE
DOI:
https://doi.org/10.21856/j-PEP.2023.4.02Keywords:
adrenal tumors, adrenal sparing surgery, adrenal resection, complexity assessment, VSLP scaleAbstract
Currently, there is no universal tool for assessing the complexity of adrenal-sparing surgery for adrenal tumors. Therefore, the aim of the work was to study the surgical features of adrenal gland resection in patients with renal cell carcinoma who had synchronous or metachronous volume formations in the adrenal glands, and based on this experience to create an original scale of the complexity of adrenal gland resections for tumors.
Materials and methods. A study of the surgical features of adrenal resection in 16 patients with renal cell carcinoma who had synchronous or metachronous adrenal masses was conducted and, based on this experience, an original scale for the evaluation of the complexity of adrenal resections for tumors was developed – VSLP (V (vena) SL (size - localization) P (parenchyma)).
Results. Parameter V characterizes the ratio of the tumor to the main adrenal vein (the tumor is located peripherally and has no risk of damage to the main adrenal vein – 0 points; the tumor is localized completely intraparenchymally or mostly intraparenchymally near the main adrenal vein and has a risk of damage – 1 point; the tumor is localized in the area of the main adrenal vein and has a high risk of damage – 2 points). The S - L parameter describes the size of the adrenal tumor (tumor up to 3 cm in size with peripheral localization or tumors in size from 1.5 cm to 3 cm with intraparenchymal or mostly intraparenchymal localization – 0 points; completely intraparenchymal tumors less than 1.5 cm or tumors more than 3 cm with intraparenchymal or mostly intraparenchymal localization – 1 point). Parameter P represents the parenchymal volume in the adrenal remnant after organ - sparing surgery (greater than 50% – 0 points; less than 50% – 1 points).
The complexity of organ-preserving operations according to the VSLP scale varies from 0 to 4 points. Surgical interventions corresponding to 0 points are easy to perform; 1 or 2 points have the average degree of difficulty; 3 points are difficult and 4 points are extremely difficult to perform.
Conclusion. The proposed scale is the first attempt to assess the complexity of organ-sparing surgery in patients with adrenal tumors based on the location and size of the neoplasm, as well as the volume of the parenchyma of the adrenal residue. Further prospective study of this predictive tool is required.
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