{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:40:39Z","timestamp":1789486839095,"version":"build-2803163510"},"reference-count":10,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The increasing detection of adrenal incidentalomas has intensified the need for clearly defined surgical indications. The 2023 European Society of Endocrinology (ESE) guidelines introduced a paradigm shift from size\u2010based to function\u2010based criteria for adrenalectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted including consecutive patients who underwent adrenal surgery between 2012 and 2023. Patients were reevaluated according to the ESE 2023 recommendations to determine whether historical surgical indications aligned with contemporary guideline\u2010defined criteria. Patients were classified as ESE\u2010positive (ESE YES) or ESE\u2010negative (ESE NO) based on hormonal activity and histopathological findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 797 consecutive patients who underwent adrenalectomy for adrenal masses. According to the ESE 2023 criteria, 541 (67.9%) patients were classified as ESE\u2010positive. Hormonal hypersecretion was present in 458 (57.8%) patients. Patients with clinically significant adrenal pathology were significantly more likely to have hormonally active tumors (81.7% vs. 4.3%,\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a0474.1, df\u00a0=\u00a01,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Median tumor diameter did not differ significantly between groups (4.5\u00a0cm [IQR 4.0\u20136.0] in the ESE\u2010positive group and 4.5\u00a0cm [IQR 3.5\u20136.0] in the ESE\u2010negative group (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.118). Median age was similar between the ESE\u2010positive and ESE\u2010negative groups (55\u00a0years [IQR 44.5\u201363.0] vs. 56\u00a0years [IQR 41.0\u201362.0],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.292).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hormonal activity is strongly associated with clinically significant adrenal pathology according to the ESE 2023 criteria, whereas tumor size alone does not appear to reliably discriminate between patients who do and do not fulfill guideline\u2010defined indications for surgery. These findings provide real\u2010world evidence supporting function\u2010driven decision\u2010making and reinforce the contemporary paradigm shift away from size\u2010based surgical indications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70518","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T18:28:10Z","timestamp":1785608890000},"page":"2648-2653","source":"Crossref","is-referenced-by-count":0,"title":["Function\u2010Driven Versus Size\u2010Driven Decision\u2010Making: Real\u2010World Evaluation of the European Society of Endocrinology Criteria in Adrenal Surgery"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5580-3247","authenticated-orcid":false,"given":"Matija","family":"Buzejic","sequence":"first","affiliation":[{"name":"Clinic for Endocrine Surgery University Clinical Center of Serbia  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0118-8450","authenticated-orcid":false,"given":"Milan","family":"Jovanovic","sequence":"additional","affiliation":[{"name":"Clinic for Endocrine Surgery University Clinical Center of Serbia  Belgrade Serbia"},{"name":"School of Medicine University of Belgrade  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branislav","family":"Rovcanin","sequence":"additional","affiliation":[{"name":"Clinic for Endocrine Surgery University Clinical Center of Serbia  Belgrade Serbia"},{"name":"School of Medicine University of Belgrade  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0249-8802","authenticated-orcid":false,"given":"Marina","family":"Stojanovic","sequence":"additional","affiliation":[{"name":"School of Medicine University of Belgrade  Belgrade Serbia"},{"name":"Center for Anesthesiology and Resuscitation University Clinical Center of Serbia  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6793-046X","authenticated-orcid":false,"given":"Katarina","family":"Tausanovic","sequence":"additional","affiliation":[{"name":"Clinic for Endocrine Surgery University Clinical Center of Serbia  Belgrade Serbia"},{"name":"School of Medicine University of Belgrade  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3999-1062","authenticated-orcid":false,"given":"Nikola","family":"Slijepcevic","sequence":"additional","affiliation":[{"name":"Clinic for Endocrine Surgery University Clinical Center of Serbia  Belgrade Serbia"},{"name":"School of Medicine University of Belgrade  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0119-2056","authenticated-orcid":false,"given":"Jovan","family":"Ilic","sequence":"additional","affiliation":[{"name":"Clinic for Endocrine Surgery University Clinical Center of Serbia  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladan","family":"Zivaljevic","sequence":"additional","affiliation":[{"name":"Clinic for Endocrine Surgery University Clinical Center of Serbia  Belgrade Serbia"},{"name":"School of Medicine University of Belgrade  Belgrade Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Endotext","author":"Chatzellis 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