Screening criteria for drainage-free patients after retroperitoneal laparoscopic adrenal tumor resection and their prospective validation study value

Retroperitoneal laparoscopic resection is the preferred minimally invasive surgery for adrenal tumors. Patients vary greatly in postoperative drain output, but no clear criteria exist to select candidates for a drainage‑free strategy. The objective of the present study was to establish clinical screening criteria for identifying patients eligible for a drainage-free strategy after retroperitoneal laparoscopic adrenal tumor resection and verify the clinical value of the criteria. A retrospective analysis was first conducted on 126 patients who underwent the aforementioned surgery. Patients were divided into two groups based on total postoperative drain output: The drainage-free group (≤60 ml, 40 cases) and the drain group (>60 ml, 86 cases). Indicators such as age and tumor diameter were compared with identify factors influencing postoperative drain output. Subsequently, a prospective validation study was carried out involving 54 patients, with 20 patients meeting the preliminary screening criteria assigned to the experimental group and 34 ineligible patients to the control group. Perioperative data and complication rates of the two groups were compared. The retrospective univariate analysis identified seven indicators (including age and tumor diameter) associated with postoperative drain output (P<0.05). Multivariate logistic regression confirmed five independent risk factors for postoperative drain output: Age [odds ratio (OR)=1.062; 95% confidence interval (CI) 1.005-1.123; P=0.033], tumor diameter (OR=2.199; 95% CI: 1.162-4.159; P=0.015), locking clip application for adrenal tissue or central vein (OR=12.081; 95% CI: 1.772-82.385; P=0.011), saponification and adhesion of adipose tissue in the surgical area (OR=0.092; 95% CI: 0.026-0.319; P<0.001) and intraoperative blood loss (OR=10.48; 95% CI: 1.025-1.072; P<0.001). In the prospective validation study, only one patient in the experimental group had postoperative drain output >60 ml (recovered with conservative treatment). The experimental group also had significantly less total drain output, shorter drain removal time and shorter hospital discharge time than the control group (P<0.05), with no significant difference in complication rates (P>0.05). In conclusion, the established screening criteria may accurately identify eligible patients. This strategy appears to safely shorten hospital stays and facilitate stratified management and may have clinical value.