1
|
Öz B, Cücük Ö, Gök M, Akcan A, Sözüer E. Laparoscopic transperitoneal adrenalectomy for adrenal tumours of 6 cm or greater: A single-centre experience. J Minim Access Surg 2024; 20:47-54. [PMID: 37148103 PMCID: PMC10898626 DOI: 10.4103/jmas.jmas_217_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the safety and efficacy of transperitoneal laparoscopic adrenalectomy (LA) for large adrenal tumours by comparing the outcomes of tumours larger than 6 cm with those smaller than 6 cm and also to identify the risk factors associated with prolonged operative time in transperitoneal LA. PATIENTS AND METHODS One hundred and sixty-three patients underwent LA at our clinic from January 2014 to December 2020. Bilateral LA was performed in 20 of these 163 patients. A total of 143 patients were included in this study. Data were analysed retrospectively from the patients' medical records collected. RESULTS Large tumour (LT) group consists of 33 patients and the small tumour (ST) group consists of 110 patients. There was no statistically significant difference between the groups regarding conversion to open surgery and complications. A multiple regression analysis was conducted to identify the independent predictors of prolonged operation time. The tumour size ≥8 cm (odds ratio [OR], 19.132; 95% confidence interval [CI], 3.881-94.303; P < 0.001) and diagnosis of pheochromocytoma (OR, 2.762; 95% CI, (1.123-6.789, P = 0.026) were the significant predictors of prolonged operation time. CONCLUSION Our study shows that LA can be considered the treatment of choice for small and large adrenal tumours. The tumour size ≥8 cm and diagnosis of pheochromocytoma are the independent risk factors for the prolonged operative time in transperitoneal LA.
Collapse
Affiliation(s)
- Bahadır Öz
- Department of General Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ömer Cücük
- Clinic of General Surgery, Gaziantep Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Mustafa Gök
- Department of General Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Alper Akcan
- Department of General Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Erdoğan Sözüer
- Department of General Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
2
|
Sahbaz NA, Dural AC, Akarsu C, Guzey D, Kulus M, Dogansen SC, Mert M, Alis H. Transperitoneal laparoscopic surgery in large adrenal masses. Wideochir Inne Tech Maloinwazyjne 2020; 15:106-111. [PMID: 32117492 PMCID: PMC7020710 DOI: 10.5114/wiitm.2019.85177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/19/2019] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The laparoscopic adrenalectomy (LA) has become the gold standard since the transperitoneal laparoscopic approach was first reported. AIM To evaluate the applicability, safety and short-term results of laparoscopic surgery in adrenal masses over 6 cm. MATERIAL AND METHODS Demographic data, hormonal activities, imaging modalities, operative findings, operation time, conversion rates, complications, duration of hospital stay and histopathologic results of 128 patients who underwent laparoscopic adrenalectomy were evaluated retrospectively. Patients included in the learning curve (n = 23), robotic surgery cases (n = 15) and patients with suspected metastasis (n = 4) were excluded from the study. Six cm mass size was taken as a reference and two groups were formed (group 1: < 6 cm, group 2: ≥ 6 cm). The results of the two groups were compared. RESULTS There were 64 cases in group 1 and 22 cases in group 2. Functional mass ratio and mass sides were similar between the groups (p = 0.30 and p = 0.17, respectively). The mean mass size in group 1 was 36.4 ±11.2 mm and in group 2 82.4 ±15.5 mm. The conversion rate was similar between the two groups (p = 0.18). The duration of surgery was 135.5 ±8.29 min in group 1, 177.0 ±14.9 min in group 2 (p = 0.014). Morbidity and lengths of hospital stay were similar (p = 0.76, p = 0.34 respectively). Adrenocortical carcinoma was detected in three cases in group 1, which were completed laparoscopically, and in two cases in group 2, which were converted to open surgery (p = 0.46). CONCLUSIONS Although open surgery is still recommended in the guidelines, studies are now being carried out to ensure that laparoscopy can be safely performed on masses over 6 cm. There was no difference between short-term follow-up and histopathologic results in our study.
Collapse
Affiliation(s)
- Nuri Alper Sahbaz
- Department of Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Cem Dural
- Department of Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Cevher Akarsu
- Department of Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Deniz Guzey
- Department of Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kulus
- Department of Surgery, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sema Ciftci Dogansen
- Department of Endocrinology, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Meral Mert
- Department of Endocrinology, Faculty of Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Halil Alis
- Department of Surgery, Faculty of Medicine, Aydin University, VM Medical Park Florya Hospital, Istanbul, Turkey
| |
Collapse
|
3
|
Computed Tomography in the Management of Adrenal Tumors: Does Size Still Matter? J Comput Assist Tomogr 2017; 41:628-632. [PMID: 28107213 DOI: 10.1097/rct.0000000000000578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to evaluate computed tomography (CT) imaging as a predictor of adrenal tumor pathology. METHODS A retrospective review was conducted of patients who underwent unilateral adrenalectomy for an adrenal mass between January 2005 and July 2015. Tumors were classified as benign, indeterminate, or malignant based on preoperative CT findings. RESULTS Of 697 patients who underwent unilateral adrenalectomy, 216 met the inclusion criteria. Pathology was benign in 88.4%, indeterminate in 2.3%, and malignant in 9.3%, with a median tumor diameter of 2.7 cm (interquartile range, 1.7-4.1 cm) and 9.5 cm (interquartile range, 7.1-12 cm) in the benign and malignant groups, respectively (P < 0.001). Of the tumors with benign features on CT, 100% (143/143) had benign final pathology. CONCLUSIONS Imaging characteristics of adrenal tumors on CT scan predict benign pathology 100% of the time. Regardless of size, when interpreted as benign on CT scan, laparoscopic adrenalectomy, if technically feasible, should be the technique used when surgery is offered, or close surveillance may be a safe alternative.
Collapse
|
4
|
Paganini AM, Guerrieri M, Balla A, Quaresima S, Isidori AM, Iafrate F, D’Ambrosio G, Lezoche G, Lezoche E. Management of adrenal incidentaloma by laparoscopic transperitoneal anterior and submesocolic approach. Langenbecks Arch Surg 2015; 401:71-9. [DOI: 10.1007/s00423-015-1367-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
|
5
|
Feo CV, Portinari M, Maestroni U, Del Rio P, Severi S, Viani L, Pravisani R, Soliani G, Zatelli MC, Ambrosio MR, Tong J, Terrosu G, Bresadola V. Applicability of laparoscopic approach to the resection of large adrenal tumours: a retrospective cohort study on 200 patients. Surg Endosc 2015; 30:3532-40. [PMID: 26541739 DOI: 10.1007/s00464-015-4643-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Controversies exist in the best surgical approach (open vs. laparoscopy) to large adrenal tumours without peri-operative evidence of primary carcinoma, mainly due to possible capsular disruption of an unsuspected malignancy. In addition, intra-operative blood loss, conversion rate, operative time, and hospital stay may be increased with laparoscopy. THE AIMS OF OUR STUDY WERE (1) to compare clinical outcomes of laparoscopic adrenalectomy for large versus small adrenal tumours and (2) to identify risk factors associated with increased operative time and hospital stay in laparoscopic adrenalectomy. METHODS This is a multicentre retrospective cohort study in a large patient population (N = 200) who underwent laparoscopic adrenalectomy in 2004-2014 at three Italian academic hospitals. Patients were divided into two cohorts according to tumour size: "large" tumours were defined as ≥5 cm (N = 50) and "small" tumours as <5 cm (N = 150). Further analysis adopting a ≥8 cm (N = 15) cut-off size was performed. RESULTS The study groups were comparable in age and gender distribution as well as their tumour characteristics. The operative time (p = 0.671), conversion rate (p = 0.488), intra- (p = 0.876) and post-operative (p = 0.639) complications, and hospital stay (p = 0.229) were similar between groups. With a cut-off size ≥5 cm, the early study period (2004-2009), which included operators' learning curve, was associated with increased risk of longer operative time (HR 0.57; 95 % CI 0.40-0.82), while American Society of Anaesthesiology score ≥3 was associated with prolonged hospital stay (HR 0.67; 95 % CI 0.47-0.97). Tumour size ≥8 cm was associated with prolonged operative time (HR 0.47; 95 % CI 0.24-0.94). CONCLUSIONS Surgeons skilled in advanced laparoscopy and adrenal surgery can perform laparoscopic adrenalectomy safely in patients with ≥5-cm tumours with no increase in hospital stay, or conversion rate, although operative time may be increased for ≥8-cm tumours. Surgeon' experience, size ≥8 cm, and patient comorbidities have the largest impact on operative time and length of hospital stay in laparoscopic large adrenal tumour resection.
Collapse
Affiliation(s)
- Carlo V Feo
- Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, S. Anna University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Mattia Portinari
- Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, S. Anna University Hospital of Ferrara, University of Ferrara, Ferrara, Italy.
- Clinica Chirurgica, Arcispedale S. Anna, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 | 1C2 Room 2 34 03, 44124, Ferrara (Cona), Italy.
| | - Umberto Maestroni
- Department of Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Paolo Del Rio
- Department of Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Silvia Severi
- Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, S. Anna University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Lorenzo Viani
- Department of Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Riccardo Pravisani
- Section of Clinica Chirurgica, Department of Medical and Biological Science, S. Maria della Misericordia University Hospital of Udine, University of Udine, Udine, Italy
| | - Giorgio Soliani
- Section of Clinica Chirurgica, Department of Morphology, Surgery, and Experimental Medicine, S. Anna University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, S. Anna University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Maria Rosaria Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, S. Anna University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Jenny Tong
- Division of Endocrinology, Duke University, Durham, NC, USA
| | - Giovanni Terrosu
- Section of Clinica Chirurgica, Department of Medical and Biological Science, S. Maria della Misericordia University Hospital of Udine, University of Udine, Udine, Italy
| | - Vittorio Bresadola
- Section of Clinica Chirurgica, Department of Medical and Biological Science, S. Maria della Misericordia University Hospital of Udine, University of Udine, Udine, Italy
| |
Collapse
|
6
|
Kanthan R, Senger JL, Kanthan S. Three uncommon adrenal incidentalomas: a 13-year surgical pathology review. World J Surg Oncol 2012; 10:64. [PMID: 22540324 PMCID: PMC3407001 DOI: 10.1186/1477-7819-10-64] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 04/27/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The discovery of adrenal incidentalomas due to the widespread use of sophisticated abdominal imaging techniques has resulted in an increasing trend of adrenal gland specimens being received in the pathology laboratory. In this context, we encountered three uncommon adrenal incidentalomas.The aim of this manuscript is to report in detail the three index cases of adrenal incidentalomas in the context of a 13-year retrospective surgical pathology review. METHODS The three index cases were investigated and analyzed in detail with relevant review of the English literature as available in PubMed and Medline. A 13-year retrospective computer-based histopathological surgical review was conducted in our laboratory and the results were analyzed in the context of evidence-based literature on adrenal incidentalomas. RESULTS A total of 94 adrenal specimens from incidentalomas were identified, accounting for 0.025% of all surgical pathology cases. In all 76.6% were benign and 23.4% were malignant. A total of 53 females (56.4%) and 41 males (43.6%) aged 4 to 85 years were identified. The benign lesions included cortical adenoma (43.1%), pheochromocytoma (29.3%) and inflammation/fibrosis/hemorrhage (8.3%). Metastatic neoplasms were the most common malignant lesions (50%) followed by primary adrenocortical carcinomas (31.8%) and neuroblastoma (13.6%). These cases were discovered as adrenal incidentalomas that led to surgical exploration.The three index cases of adrenal incidentalomas with unusual pathologies were encountered that included (a) adrenal ganglioneuroma, (b) periadrenal schwannoma and (c) primary adrenal pleomorphic leiomyosarcoma. These cases are discussed, with a literature and clinicopathological review. CONCLUSIONS Adrenal lesions are uncommon surgical specimens in the pathology laboratory. However, higher detection rates of adrenal incidentalomas aided by the ease of laparoscopic adrenalectomy has resulted in increased adrenal surgical specimens leading to unsuspected diagnostic and management dilemmas. Accurate pathological identification of common and uncommon adrenal incidentalomas is essential for optimal patient management.
Collapse
Affiliation(s)
- Rani Kanthan
- Department of Pathology and Laboratory Medicine, Saskatoon, Saskatchewan, Canada
- Room 2868 G-Wing, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0 W8, Canada
| | - Jenna-Lynn Senger
- Department of Pathology and Laboratory Medicine, Saskatoon, Saskatchewan, Canada
| | - Selliah Kanthan
- Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
7
|
Dalvi AN, Thapar PM, Vijay Kumar K, Kamble RS, Rege SA, Deshpande AA, Shah NS, Menon PS. Laparoscopic adrenalectomy: Gaining experience by graded approach. J Minim Access Surg 2011; 2:59-66. [PMID: 21170236 PMCID: PMC2997274 DOI: 10.4103/0972-9941.26649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 06/10/2006] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Laparoscopic adrenalectomy (LA) has become a gold standard in management of most of the adrenal disorders. Though report on the first laparoscopic adrenalectomy dates back to 1992, there is no series of LA reported from India. Starting Feb 2001, a graded approach to LA was undertaken in our center. Till March 2006, a total of 34 laparoscopic adrenalectomies were performed with success. MATERIALS AND METHODS The endocrinology department primarily evaluated all patients. Patients were divided into Group A - unilateral LA and Group B - bilateral LA (BLA). The indications in Group A were pheochromocytoma (n=7), Conn's syndrome (n=3), Cushing's adenoma (n=2), incidentaloma (n=2); and in Group B, Cushing's disease (CD) following failed trans-sphenoid pituitary surgery (n = 8); ectopic ACTH- producing Cushing's syndrome (n=1) and congenital adrenal hyperplasia (CAH) (n=1). The lateral transabdominal route was used. RESULTS The age group varied from 12-54 years, with mean age of 28.21 years. Average duration of surgery in Group A was 166.43 min (40-270 min) and 190 min (150-310 min) in Group B. Average blood loss was 136.93 cc (20-400 cc) in Group A and 92.5 cc (40-260 cc) in Group B. There was one conversion in each group. Mean duration of surgical stay was 1.8 days (1-3 days) in Group A and 2.6 days (2-4 days) in Group B. All the patients in both groups were cured of their illness. Three patients in Group B developed Nelson's syndrome. The mean follow up was of 24.16 months (4-61 months). CONCLUSION LA though technically demanding, is feasible and safe. Graded approach to LA is the key to success.
Collapse
Affiliation(s)
- Abhay N Dalvi
- Department of General Surgery, Seth G S Medical College & KEM Hospital, Mumbai - 400 012, India
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Linos D, Tsirlis T, Kapralou A, Kiriakopoulos A, Tsakayannis D, Papaioannou D. Adrenal ganglioneuromas: incidentalomas with misleading clinical and imaging features. Surgery 2010; 149:99-105. [PMID: 20452635 DOI: 10.1016/j.surg.2010.03.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 03/24/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ganglioneuromas are benign neoplasms of the neural crest, occurring rarely in the adrenal glands. This study presents our experience regarding diagnostic and therapeutic management of these neoplasms and a review of the relevant literature. METHODS Among 150 patients with of incidentalomas, we had 7 primary ganglioneuromas. Their clinical, imaging, and operative data were collected retrospectively, and the literature was reviewed using MEDLINE. There were 4 females and 3 males, with mean age of 50 years (range, 39-64). All neoplasms were discovered incidentally with ultrasonography and were evaluated subsequently with computed tomography (CT). One patient was studied further with (131)I-MIBG due to asymptomatic increased in urine vanillylmandelic acid, and 1 patient with history of breast cancer underwent additional FDG-PET/CT. RESULTS All but 2 patients were asymptomatic. Two patients complained of epigastric pain and hypertension, respectively. The preoperative mean size on CT was 6.8 cm, whereas the postoperative true mean histologic size was 7.7 cm. Both patients who were evaluated with radionuclide studies had false positive results, suggestive of pheochromocytoma and adrenal metastasis, respectively. Three patients underwent open adrenalectomy due to preoperative suspicion of carcinoma, and the remaining 4 underwent laparoscopic anterior adrenalectomy. Histologically, all 7 neoplasms were completely differentiated, mature ganglioneuromas. We had no mortality or significant morbidity. No recurrence occurred during a mean follow-up of 6 years (range, 1-18). CONCLUSION Adrenal ganglioneuromas are rare incidentalomas that can mimic primary or secondary adrenal malignancies as well as pheochromocytomas. Despite their usually large size, resection via laparoscopic approach is safe and effective.
Collapse
Affiliation(s)
- Dimitrios Linos
- 1st Surgical Clinic, Diagnostic and Therapeutic Center of Athens Hygeia, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
9
|
|
10
|
Abstract
Open adrenalectomy has been the gold-standard therapy for adrenal neoplasms. Minimally invasive treatments, however, have assumed a more central role in the management of these lesions. The traditional benefits of laparoscopy, including reduced blood loss, shorter hospital duration, and improved convalescence, extend to adrenal disease without compromising the oncologic efficacy of the surgery. Contemporary series suggest that minimally invasive surgery is also a reasonable therapeutic modality for larger adrenal masses. Laparoscopic adrenalectomy for these large masses is a technically demanding procedure that should be undertaken by experienced laparoscopic surgeons familiar with retroperitoneal anatomy and adept with vascular techniques in the event of an open conversion. Oncologic outcomes collectively suggest that in the setting of adequate surgical resection, recurrence patterns relate more to disease-process biology than surgical approach. Neither size criteria, suspicion of malignancy, nor locally invasive disease should be considered an absolute contraindication to laparoscopic adrenalectomy.
Collapse
Affiliation(s)
- James S Rosoff
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, Starr 900, New York, NY 10065, USA
| | | | | |
Collapse
|
11
|
Over 10 Years of Experience in the Laparoscopic Treatment of Adrenal Lesions via Lateral Transperitoneal Approach. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0069-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Vardanian AJ, Hines OJ, Farrell JJ, Yeh MW. Incidentally discovered tumors of the endocrine glands. Future Oncol 2007; 3:463-74. [PMID: 17661721 DOI: 10.2217/14796694.3.4.463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Clinically inapparent masses, or ‘incidentalomas’ of the endocrine glands are increasingly common owing to continued advancements in medical imaging. Incidentalomas of the adrenal glandS have received substantial attention in the literature, whereas lesions of the thyroid and endocrine pancreas, though frequently encountered in the clinic, have received relatively little attention. We review the detection and subsequent management of incidentalomas of the thyroid, adrenal and pancreas, with specific attention paid to the mode of detection and risk stratification of lesions.
Collapse
Affiliation(s)
- Andrew J Vardanian
- UCLA David Geffen School of Medicine, Department of Surgery, Los Angeles, CA 90095, USA.
| | | | | | | |
Collapse
|
13
|
Chavez-Rodriguez J, Pasieka JL. Adrenal lesions assessed in the era of laparoscopic adrenalectomy: a modern day series. Am J Surg 2005; 189:581-5; discussion 585-6. [PMID: 15862500 DOI: 10.1016/j.amjsurg.2005.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 02/01/2005] [Accepted: 02/01/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND To evaluate if laparoscopic adrenalectomy (LA) has changed the indications for adrenalectomy. METHODS Retrospective analysis of patients with adrenal lesions referred from 1992 to 2004. Patients were divided into 2 groups, those before and those after the introduction of LA. RESULTS One hundred eighty patients were assessed. Functioning lesions were found in 120 (66%) patients. Sixty patients had nonfunctioning tumors. Before the introduction of LA, 13% had primary hyperaldosteronism (PA), 23% had pheochromocytoma (Pheo), 20% had Cushing's syndrome (CS), and 7% had adrenal cortical cancer (ACC). No difference was seen in the percentage of patients referred after LA with Pheo (20%), CS (16%), or ACC (6%). There was, however, a significant increase in the percentage of patients referred with PA after introducing LA (13% vs. 27%), P < .05. CONCLUSION Indications for adrenalectomy have not changed since introduction of LA. There was, however, an increased percentage of patients with PA referred since the introduction of LA.
Collapse
Affiliation(s)
- J Chavez-Rodriguez
- Department of Surgery, University of Calgary, 1403 29th St. N.W., Calgary, Alberta, Canada T2N 2T9
| | | |
Collapse
|
14
|
Abstract
Laparoscopic adrenalectomy for primary malignancies and tumors metastatic to the adrenal is controversial. Most studies demonstrate that results of laparoscopic adrenalectomy for malignant lesions are similar to those of open adrenalectomy, without its morbidity. The results of laparoscopic adrenalectomy for tumor metastases suggest that it may benefit patients who have a metachronous metastasis from any of a variety of primary tumors. Selective laparoscopic adrenalectomy for potentially malignant tumors requires seeking signs of local invasion, lymphadenopathy, or distant metastasis; there are no other reliable preoperative criteria of malignancy. Diagnostic laparoscopy may be useful, and in some cases, may establish a diagnosis. Laparoscopic adrenalectomy should be cautiously performed, with the goals of achieving complete tumor resection without disruption of the adrenal capsule.
Collapse
Affiliation(s)
- Cord Sturgeon
- Department of Surgery, University of California, San Francisco Comprehensive Cancer Center at Mount Zion Medical Center, 1600 Divisadero Street, Hellman Building, Room C3-47, San Francisco, California 94143-1674, USA
| | | |
Collapse
|
15
|
Abstract
Adrenocortical carcinoma is a rare cancer that historically has been associated with poor outcome. Throughout the past decades, growing experience has allowed better understanding of the natural history and optimal management of this cancer. Advances in imaging and aggressive surgical therapy have raised the outlook for recently diagnosed patients. Further improvements in survival will require more effective systemic therapy.
Collapse
Affiliation(s)
- David Y T Chen
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical Center, Starr 900, 525 East 68th Street, New York, NY 10021, USA.
| | | | | |
Collapse
|
16
|
Kouriefs C, Leris ACA, Mokbel K, Grossman AB, Reznek R, Carpenter R. Abdominal ganglioneuromas in adults. Urol Int 2003; 71:110-3. [PMID: 12845274 DOI: 10.1159/000071107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2001] [Accepted: 12/12/2001] [Indexed: 11/19/2022]
Abstract
Ganglioneuromas are rare tumours of the parasympathetic nervous system. Their definitive diagnosis is made on histological examination. When they arise from the adrenal medulla, their assessment and management are the same as those of other adrenal tumours. We here report 3 cases of ganglioneuromas highlighting important points regarding the radiological assessment, management, decision making and surgical approaches.
Collapse
Affiliation(s)
- C Kouriefs
- Endocrine Surgical Unit, St. Bartholomew's Hospital, London, UK.
| | | | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- Saleh M Al Salamah
- Department of Surgery, College of Medicine, King Saud University, Saudi Arabia
| |
Collapse
|