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Li X, Xiao S, Zhan X, Yu Y, Zhang C, Xi H, Wang G, Zhou X. For small (1-3cm) nonfunctional adrenal incidentaloma (NFAI), which option is more appropriate for conservative treatment or surgery? Front Endocrinol (Lausanne) 2023; 14:1119251. [PMID: 36817594 PMCID: PMC9929361 DOI: 10.3389/fendo.2023.1119251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To compare the efficacy and safety between conservative treatment and surgery for the patients with small (1-3cm) nonfunctional adrenal incidentaloma (NFAI). METHODS The patients with small (1-3cm) NFAI who received conservative treatment or surgery in our hospital from November 2018 to December 2019 were retrospectively collected. A total of 83 patients were included in this study. They were divided into two groups according to the treatment methods: the surgery group (n=51) and the conservative treatment group (n=32).Then patients' demographics, tumor characteristics, functional indicators and complications were compared. Statistical analysis was performed using t-test for continuous variables and Pearson chi-square test or Fisher's exact test for categorical variables. RESULTS At the time of diagnosis, after 3 months, after 6 months, after 12 months, and after 24 months, we found that there was no significant difference between the two groups in systolic blood pressure, diastolic blood pressure, serum potassium levels, and hormone levels. 51 patients chose to have surgery, of which 41 patients chose RLA and 10 patients chose RARLA. RARLA group patients had the highest total cost and conservative treatment group patients had the lowest cost, and the difference was significant (P < 0.001). There was no significant difference in tumor size in the conservative treatment group between at the time of diagnosis and after 24 months (P = 0.305). CONCLUSION Surgical treatment is more effective for 1-3cm NFAI, but conservative treatment is safer and more economical. Follow-up after conservative or surgical treatment is necessary.
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Affiliation(s)
| | | | | | | | | | - Haibo Xi
- *Correspondence: Xiaochen Zhou, ; Gongxian Wang, ; Haibo Xi,
| | - Gongxian Wang
- *Correspondence: Xiaochen Zhou, ; Gongxian Wang, ; Haibo Xi,
| | - Xiaochen Zhou
- *Correspondence: Xiaochen Zhou, ; Gongxian Wang, ; Haibo Xi,
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Affiliation(s)
- Riccardo Autorino
- Division of Urology, Department of Surgery, VCU Health, 980118, Richmond, VA, 23298-0118, USA.
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
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Robotic bilateral partial adrenalectomy. World J Urol 2021; 40:607-609. [PMID: 33388920 DOI: 10.1007/s00345-020-03541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022] Open
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Abstract
Currently, laparoscopic adrenalectomy is worldwide considered the gold standard technique. Both transperitoneal and retroperitoneal approaches have proved their efficacy with excellent outcomes. Since the introduction of da Vinci System (Intuitive Surgical, Sunnyvale, CA), robotic surgery has made many steps forward gaining progressively more diffusion in the field of general and endocrine surgery. The robotic technique offers advantages to overcome some laparoscopic shortcomings (rigid instruments, loss of 3D vision, unstable camera). Indeed, the robotic system is provided of stereoscopic 3D-magnified vision, additional degree of freedom, tremor-filtering technology and a stable camera. Recently, several case series have demonstrated the feasibility and the safety of robot-assisted adrenalectomy in high-volume centers with outcomes comparable to laparoscopic adrenalectomy. Notwithstanding, the technical advantages of the robotic system have not yet demonstrated significant improvements in terms of outcomes to undermine laparoscopic adrenalectomy. Moreover, robotic adrenalectomy harbor inherits drawbacks, such as longer operative time and elevated costs, that limit its use. In particular, the high cost associated with the use of the robotic system is primarily related to the purchase and the maintenance of the unit, the high instruments cost and the longer operative time. Notably, these aspects make robotic adrenalectomy up to 2.3 times more costly than laparoscopic adrenalectomy. This literature review summarizes the current available studies and provides an overview about the robotic scenario including applicability, technical details and surgical outcomes.
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Mușină AM, Huțanu I, Scripcariu DV, Aniței MG, Filip B, Hogea M, Radu I, Gavrilescu MM, Panuță A, Buna-Arvinte M, Moraru VG, Scripcariu V. SURGICAL MANAGEMENT OF THE ADRENAL GLAND TUMORS - SINGLE CENTER EXPERIENCE. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:208-215. [PMID: 33029238 DOI: 10.4183/aeb.2020.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Context Incidentally discovered solid adrenal tumors must be evaluated from two points of view: the risk of malignancy and the secretory feature. Objective Our aim was to evaluate the surgical technique option in relation with clinical and histopathologic features. Design We performed a retrospective study that included patients with adrenal gland tumors. Subjects and methods All patients were operated between 2012 and 2019 by the same surgical team in a single center. Results The batch included 102 patients with adrenal tumors operated through open surgery (OS, n=41) and laparoscopic surgery (LS, n=61). Tumor localization was especially on the right adrenal gland (n=52, 50.98%). Primary origin of the adrenal gland tumors was in 82 cases (80.39%) and a metastatic origin in 16 cases. Average dimension for surgical resected tumors was 4.02 cm (0.9-12 cm) for the LS group as compared to 7.22 cm (1.3-19 cm) for OS group with a predominant type of surgery represented by adrenalectomy and a conversion rate of 2.94%. The hospital stay was 7.22 days (5-12 days) in the LS group versus 12.72 days (6-57 days) in OS group with significant differences (p<0.01). Also, the postoperative recovery was significantly different (6.5 days versus 2.62 days, p<0.01). Conclusion Laparoscopic approach represents the gold standard in adrenal gland tumors less than five centimeters in size. Adrenalectomy is mostly performed by LS and adenoma is the most frequent histopathologic type, while pheochromocytoma is operated through OS. LS has a significantly reduced hospitalization and postoperative stay compared to OS.
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Affiliation(s)
- A M Mușină
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - I Huțanu
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - D V Scripcariu
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - M G Aniței
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - B Filip
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - M Hogea
- Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - I Radu
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - M M Gavrilescu
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - A Panuță
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - M Buna-Arvinte
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - V G Moraru
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
| | - V Scripcariu
- "Grigore T. Popa" University of Medicine and Pharmacy - Surgical Department, Iasi, Romania.,Regional Institute of Oncology Iasi - 1 Surgical Oncology Unit, Iasi, Romania
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