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Piccoli M, De Luca GM, Pasculli A, Angelini M, Guicciardi L, Mullineris B, Marchi D, Melotti G. Laparoscopic transperitoneal left adrenalectomy and wandering spleen risk. JSLS 2016; 18:JSLS-D-13-00278. [PMID: 25392630 PMCID: PMC4154420 DOI: 10.4293/jsls.2014.00278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: Laparoscopic transperitoneal left adrenalectomy (LTLA) has become the standard treatment for adrenal masses <6 cm. LTLA involves the dissection of splenic suspensory ligaments, which replicates their congenital absence or weakening, present in cases of wandering spleen (WS). WS is a rare condition in which the spleen migrates from the left upper quadrant to a more caudal location in the abdomen. A unique case of WS after LTLA was described by Corcione et al. In this prospective study, we investigated the possibility of WS as a consequence of LTLA. Methods: Twenty-four patients, 8 men and 16 women, who underwent LTLA with the dissection of splenoparietal and splenorenal ligaments were selected. Results: Clinical and ultrasonographic follow-up showed no evidence of postoperative WS. Conclusions: In the literature, WS is not commonly reported as a postoperative complication of LTLA. In effect, especially in the case of small adrenal masses, the spleen's repositioning in its seat is autonomous. However, the alarming possibility of WS should not be ignored, especially in the case of extensive dissection of the left colic flexure. It would be useful for other authors to signal this complication, so that different approaches and consequent results may be compared.
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Affiliation(s)
- Micaela Piccoli
- Department of General Surgery, New S. Agostino Estense Hospital N.O.C.S.A.E. Baggiovara, Modena, Italy
| | - Giuseppe Massimiliano De Luca
- Department of Biomedical Sciences and Human Oncology, Section of General and Oncologic Surgery, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
| | - Alessandro Pasculli
- Department of Biomedical Sciences and Human Oncology, Section of General and Oncologic Surgery, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
| | - Marta Angelini
- Department of Radiology, Vignola Hospital, Vignola, Italy
| | - Lorenzo Guicciardi
- Department of General Surgery, New S. Agostino Estense Hospital N.O.C.S.A.E. Baggiovara, Modena, Italy
| | - Barbara Mullineris
- Department of General Surgery, New S. Agostino Estense Hospital N.O.C.S.A.E. Baggiovara, Modena, Italy
| | - Domenico Marchi
- Department of General Surgery, New S. Agostino Estense Hospital N.O.C.S.A.E. Baggiovara, Modena, Italy
| | - Gianluigi Melotti
- Department of General Surgery, New S. Agostino Estense Hospital N.O.C.S.A.E. Baggiovara, Modena, Italy
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Machado NO, Al Qadhi H, Al Wahaibi K, Rizvi SG. Laparoscopic Adrenalectomy for Large Adrenocortical Carcinoma. JSLS 2016; 19:JSLS.2015.00036. [PMID: 26175553 PMCID: PMC4487957 DOI: 10.4293/jsls.2015.00036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Adrenocortical cancer (ACC) is a rare disease that is difficult to treat. Laparoscopic adrenalectomy (LA) is performed, even for large adrenocortical carcinomas. However, the oncological effectiveness of LA remains unclear. This review presents the current knowledge of the feasibility and oncological effectiveness of laparoscopic surgery for ACC, with an analysis of data for outcomes and other parameters. Database: A systematic review of the literature was performed by searching the PubMed and Medline databases for all relevant articles in English, published between January 1992 and August 2014 on LA for adrenocortical carcinoma. Discussion: The search resulted in retrieval of 29 studies, of which 10 addressed the outcome of LA versus open adrenalectomy (OA) and included 844 patients eligible for this review. Among these, 206 patients had undergone LA approaches, and 638 patients had undergone OA. Among the 10 studies that compared the outcomes obtained with LA and OA for ACC, 5 noted no statistically significant difference between the 2 groups in the oncological outcomes of recurrence and disease-free survival, whereas the remaining 5 reported inferior outcomes in the LA group. Using a paired t test for statistical analysis, except for tumor size, we found no significant difference in local recurrence, peritoneal carcinomatosis, positive resection margin, and time to recurrence between the LA and OA groups. The overall mean tumor size in patients undergoing LA and OA was 7.1 and 11.2 cm, respectively (P = .0003), and the mean overall recurrence was 61.5 and 57.9%, respectively. The outcome of LA is believed to depend to a large extent on the size and stage of the lesion (I and II being favorable) and the surgical expertise in the center where the patient undergoes the operation. However, the present review shows no difference in the outcome between the 2 approaches across all stages. A poor outcome is likely to result from inadequate surgery, irrespective of whether the approach is open or laparoscopic.
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Affiliation(s)
| | - Hani Al Qadhi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Syed G Rizvi
- Department of Family Medicine and Public Health, Muscat, Oman
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What is the appropriate role of minimally invasive vs. open surgery for small adrenocortical cancers? Curr Opin Oncol 2015; 27:44-9. [PMID: 25390555 DOI: 10.1097/cco.0000000000000144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The role of endoscopic adrenalectomy for adrenocortical carcinoma is the most controversial and debated points in adrenal surgery. We reviewed the most recent literature on this topic. RECENT FINDINGS From the amount of available data (even if not conclusive), the following could be extrapolated: first, for patients with apparently localized disease the adrenal gland should be removed en bloc with the entire retroperitoneal fat pad, which also includes some periadrenal lymph nodes, but no extended resection is necessary in absence of involvement of adjacent structures; second, in experienced centers, oncologic outcome for endoscopic adrenalectomy is not inferior to open adrenalectomy when strict selection criteria and the principles of oncologic surgery are respected. When performed by nonexperienced surgeons, endoscopic adrenalectomy may be associated with a higher rate of positive margin and local recurrence; third, patients observed at specialized referral centers receive a more accurate preoperative workup that allows a better operative planning and a more comprehensive postoperative treatment. SUMMARY Although waiting for further more exhaustive studies, we think that for suspected adrenocortical carcinoma, smaller than 8-10 cm and without pre or intraoperative evidence of local invasion, endoscopic adrenalectomy in a referral center seems to be an acceptable option.
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Gama Filho JBD, Rodrigues DF, Mendes FF, Gama BL, Santos RBS, Corrêa LR, Borges JRJ, Silva LAFD, Paulo NM. LAPAROSCOPIC TECHNIQUE VERSUS OPEN TECHNIQUE IN SWINES ADRENALECTOMY. CIÊNCIA ANIMAL BRASILEIRA 2015. [DOI: 10.1590/1089-6891v16i219209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Among the main benefits of laparoscopic adrenalectomy (LA) compared to open adrenalectomy (OA) the rapid recovery of patients with decreased length of stay in hospital can be highlighted. The objective of this study was to compare the open adrenalectomy with laparoscopic adrenalectomy in swine. Thirty-two swine were operated. The animals had been divided into four groups (n = 8), one group was submitted to OA and the other to LA, together with its respective control group. Parameters were evaluated regarding operative time, body temperature, hematocrit, postoperative and intraoperative complications and time to deambulation. There was no meaningful difference between operative and deambulation times, even though the latter having been higher in the group submitted to OA. The most frequent intercurrences were in bowel, damage to adrenal vessels and renal hematoma. There were no significant blood losses, and observed hypothermia did not have any clinical impact. Laparoscopy in swine experimental adrenalectomy is a reliable technique that can serve as a reference for the surgical treatment of patients with adrenal diseases with surgical indications in other animal species.
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Pahwa M, Pahwa AR, Batra R, Abraham RR, Chawla A, Kathuria S, Sharma A. Robotic assisted laparoscopic adrenalectomy: Initial experience from a tertiary care centre in India. J Minim Access Surg 2015; 11:83-6. [PMID: 25598605 PMCID: PMC4290125 DOI: 10.4103/0972-9941.147704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/14/2014] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Laparoscopic adrenalectomy (LA) is now considered the standard for treatment of surgically correctable adrenal disorders. Robotic adrenalectomy has been performed worldwide and has established itself as safe, feasible and effective approach. We hereby present the first study in robotic transperitoneal LA from Indian subcontinent. MATERIALS AND METHODS We conducted a retrospective evaluation of 25 patients who had undergone robotic assisted LA at a tertiary health centre by a single surgeon. Demographic, clinical, histopathological and perioperative outcome data were collected and analysed. RESULTS Mean age of the patients was 45 years (range: 27-65 years). Eleven male and 14 female patients were operated. Mean operative time was 139 min ± 30 min (range: 110-232 min) and mean blood loss was 85 ml ± 12 ml (range: 34-313 ml). Mean hospital stay was 2.5 ± 1.05 days (range: 2-6 days). Mean visual analogue scale score was 3.2 (range: 1-6) mean analgesic requirement was 50 mg diclofenac daily (range: 0-150 mg). Histopathological evaluation revealed 11 adenomas, eight phaeochromocytomas, two adrenocortical carcinomas, and four myelolipomas. According to Clavien-Dindo classification, three patients developed Grade I post-operative complications namely hypotension and pleural effusion. CONCLUSION Robotic adrenalectomy is safe, technically feasible and comfortable to the surgeon. It is easier to perform with a short learning curve.
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Affiliation(s)
- Mrinal Pahwa
- Department of Urology, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Radhika Batra
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
| | - Rtika Ryfka Abraham
- Department of Endocrinology, University of Arkansas Medical Sciences, Hofstra, USA
| | - Arun Chawla
- Department of Nephrology, South Kidney Specialist, Hofstra, USA
| | - Sachin Kathuria
- Department of Urology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ajay Sharma
- Department of Urology, Sir Ganga Ram Hospital, New Delhi, India
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Donatini G, Caiazzo R, Do Cao C, Aubert S, Zerrweck C, El-Kathib Z, Gauthier T, Leteurtre E, Wemeau JL, Vantyghem MC, Carnaille B, Pattou F. Long-term survival after adrenalectomy for stage I/II adrenocortical carcinoma (ACC): a retrospective comparative cohort study of laparoscopic versus open approach. Ann Surg Oncol 2013; 21:284-91. [PMID: 24046101 DOI: 10.1245/s10434-013-3164-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is the standard treatment for benign adrenal lesions. The laparoscopic approach has also been increasingly accepted for adrenal metastases but remains controversial for adrenocortical carcinoma (ACC). In a retrospective cohort study we compared the outcome of LA versus open adrenalectomy (OA) in the treatment of stage I and II ACC. METHODS This was a double cohort study comparing the outcome of patients with stage I/II ACC and a tumor size <10 cm submitted to LA or OA at Lille University Hospital referral center from 1985 to 2011. Main outcomes analyzed were: postoperative morbidity, overall survival, and disease-free survival. RESULTS Among 111 consecutive patients operated on for ACC, 34 met the inclusion criteria. LA and OA were performed in 13 and 21 patients, respectively. Baseline patient characteristics (gender, age, tumor size, hormonal secretion) were similar between groups. There was no difference in postoperative morbidity, but patients in LA group were discharged earlier (p < 0.02). After a similar follow-up (66 ± 52 for LA and 51 ± 43 months for OA), Kaplan-Meier estimates of disease-specific survival and disease-free survival were identical in both groups (p = 0.65, p = 0.96, respectively). CONCLUSIONS LA was associated with a shorter length of stay and did not compromise the long-term oncological outcome of patients operated on for stage I/II ACC ≤ 10 cm ACC. Our results suggest that LA can be safely proposed to patients with potentially malignant adrenal lesions smaller than 10 cm and without evidence of extra-adrenal extension.
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Affiliation(s)
- Gianluca Donatini
- Department of General and Endocrine Surgery, Lille Regional University Hospital, Lille, France
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Laparoscopic adrenalectomy for malignant lesions: surgical principles to improve oncologic outcomes. Surg Endosc 2013; 27:2321-6. [DOI: 10.1007/s00464-012-2772-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 12/12/2012] [Indexed: 01/28/2023]
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Gaujoux S, Bertherat J, Dousset B, Groussin L. Laparoscopic adrenalectomy for adrenocortical carcinoma: A medico-surgical perspective. ANNALES D'ENDOCRINOLOGIE 2012; 73:441-7. [DOI: 10.1016/j.ando.2012.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 07/18/2012] [Indexed: 10/27/2022]
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Lebastchi AH, Kunstman JW, Carling T. Adrenocortical Carcinoma: Current Therapeutic State-of-the-Art. JOURNAL OF ONCOLOGY 2012; 2012:234726. [PMID: 23125857 PMCID: PMC3483813 DOI: 10.1155/2012/234726] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 08/13/2012] [Accepted: 08/27/2012] [Indexed: 12/24/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy that generally conveys a poor prognosis. Currently, surgical resection is considered the lone curative treatment modality. In addition, the low prevalence of ACC has limited effective clinical trial design to develop evidence-based approaches to ACC therapy. The proper role of radio- and chemotherapy treatment for ACC is still being defined. Similarly, the molecular pathogenesis of ACC remains to be fully characterized. Despite these challenges, progress has been made in several areas. After years of refinement, an internationally accepted staging system has been defined. International collaborations have facilitated increasingly robust clinical trials, especially regarding agent choice and patient selection for chemotherapeutics. Genetic array data and molecular profiling have identified new potential targets for rational drug design as well as potential tumor markers and predictors of therapeutic response. However, these advances have not yet been translated into a large outcomes benefit for ACC patients. In this paper, we summarize established therapy for ACC and highlight recent findings in the field that are impacting clinical practice.
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Affiliation(s)
- Amir H. Lebastchi
- Department of Surgery, Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, 333 Cedar Street, TMP202, Box 208062, New Haven, CT 06520, USA
| | - John W. Kunstman
- Department of Surgery, Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, 333 Cedar Street, TMP202, Box 208062, New Haven, CT 06520, USA
| | - Tobias Carling
- Department of Surgery, Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, 333 Cedar Street, TMP202, Box 208062, New Haven, CT 06520, USA
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Adrenocortical carcinoma: which surgical approach? Langenbecks Arch Surg 2011; 397:195-9. [PMID: 21947510 DOI: 10.1007/s00423-011-0852-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 09/08/2011] [Indexed: 12/22/2022]
Abstract
INTRODUCTION There are no randomised studies comparing open and laparoscopic approaches foradrenalectomy in patients with adrenal cortical carcinoma. METHODS There is evidence of postoperative benefit for the patients undergoing laparoscopic adrenalectomy compared to open adrenalectomy (level B). RESULTS Results from comparison of oncological outcomes in ACC between open and laparoscopic approaches are equivocal: increasedrisk of local recurrence and peritoneal carcinomatosis by the laparoscopic route (level D), and identical results between the two approaches in terms of survival, recurrence and peritoneal carcinomatosis (level C). CONCLUSION An open approach is recommended in case of local invasion, with a view to achieving an R0 resection (level D). Laparoscopic resection of ACC/potentially malignant tumours, which includes removal of surrounding periadrenal fat and results in an R0 resection without tumour capsule rupture, may be performed for preoperative and intraoperative stage 1-2 ACC and tumours with a diameter < 10 cm (level C).
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Miller BS, Ammori JB, Gauger PG, Broome JT, Hammer GD, Doherty GM. Laparoscopic resection is inappropriate in patients with known or suspected adrenocortical carcinoma. World J Surg 2010; 34:1380-5. [PMID: 20372905 DOI: 10.1007/s00268-010-0532-2] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Complete surgical resection is the mainstay of treatment for patients with adrenocortical cancer (ACC). Use of laparoscopy has been questioned in patients with ACC. This study compares the outcomes of patients undergoing laparoscopic versus open resection (OR) for ACC. METHODS A retrospective review (2003-2008) of patients with ACC was performed. Data were collected for demographics, operative and pathologic data, adjuvant therapy, and outcome. Chi-square analysis was performed. RESULTS Eighty-eight patients (66% women; median age, 47 (range, 18-81) years) were identified. Seventeen patients underwent laparoscopic adrenalectomy (LA). Median tumor size of those who underwent LA was 7.0 (range, 4-14) cm versus 12.3 (range, 5-27) cm for OR. Recurrent disease in the laparoscopic group occurred in 63% versus 65% in the open group. Mean time to first recurrence for those who underwent LA was 9.6 months (+/-14) versus 19.2 months (+/-37.5) in the open group (p < 0.005). Fifty percent of patients who underwent LA had positive margins or notation of intraoperative tumor spill versus 18% of those who underwent OR (p = 0.01). Local recurrence occurred in 25% of the laparoscopic group versus 20% in the open group (p = 0.23). Mean follow-up was 36.5 months (+/-43.6). CONCLUSIONS ACC continues to be a deadly disease, and little to no progress has been made from a treatment standpoint in the past 20 years. Careful and complete surgical resection is of the utmost importance. Although feasible in many cases and tempting, laparoscopic resection should not be attempted in patients with tumors suspicious for or known to be adrenocortical carcinoma.
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Affiliation(s)
- B S Miller
- Division of Endocrine Surgery, University of Michigan, 2920F Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
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Abstract
In this era of modern technologies, laparoscopic adrenalectomy is a gold standard surgical treatment for benign adrenal lesions. However, being aware of its difficulties and their managements is a very important issue for the surgeons who are interested in minimal invasive surgery. In this article, we are presenting a case of a 57-year-old woman who has undergone laparoscopic left adrenalectomy and in the third postoperative month, had an acute gastric volvulus requiring surgical open treatment. To the best of our knowledge, this report is the first article about a gastric volvulus case after left laparoscopic adrenalectomy.
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Abstract
PURPOSE OF REVIEW Laparoscopic adrenalectomy for malignant adrenal masses has been controversial because of initial reports of high rates of local recurrence and carcinomatosis. With additional experience, improved outcomes have been reported. We evaluate the contemporary role of laparoscopy in treating adrenal malignancies. RECENT FINDINGS Several contemporary reports now demonstrate that laparoscopic adrenalectomy for primary adrenal malignancy can provide oncologic outcomes equivalent to open surgery without an increased risk of carcinomatosis or port site recurrence. Although long-term survival of 47 months with no recurrence has been reported, the underlying aggressiveness of this tumor has contributed to a 39.6% rate of recurrence for the 48 contemporary cases reviewed in this article. This compares favorably to open series that report a similar or higher recurrence rate. When utilized for the treatment of solitary metastases to the adrenal gland, laparoscopic adrenalectomy provides equivalent oncologic outcomes to open adrenalectomy. SUMMARY Laparoscopic adrenalectomy for malignancy can be performed in appropriately selected cases with equal oncologic outcomes to open approaches while providing advantages in patient morbidity. Caution must be taken to avoid tumor entry or spillage because of the potential for local recurrence, port site recurrence, and carcinomatosis that can occur with these aggressive tumors.
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Kirshtein B, Yelle JD, Moloo H, Poulin E. Laparoscopic adrenalectomy for adrenal malignancy: a preliminary report comparing the short-term outcomes with open adrenalectomy. J Laparoendosc Adv Surg Tech A 2008; 18:42-6. [PMID: 18266573 DOI: 10.1089/lap.2007.0085] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The laparoscopic approach to adrenal malignancy remains a topic of debate. METHODS A retrospective analysis of patients who had an open or laparoscopic adrenalectomy for malignancy at a tertiary care center from 1995 to 2005 were included in this study. RESULTS Twenty-six cases were identified: 19 women and 7 men with a median age of 48 years (range, 20-81) underwent 12 open (8 adrenocortical carcinoma [ACC] and 4 metastases) and 14 laparoscopic adrenalectomies (5 ACC, 8 metastases, and 1 lymphoma). Conversion to open surgery was required in 1 laparoscopic case (7%). Cases with obvious invasion to adjacent organs were not approached laparoscopically. There was no difference in age, sex, American Society of Anesthesiologists status or diagnosis between the two groups, but patients in the laparoscopic group had a higher body mass index. Two patients required splenectomies for splenic tears in the open group. There was no difference in operative time between the two groups, but estimated blood loss (200 vs. 550 mL; P = 0.01) and hospital stay (2 vs. 7 days; P = 0.005) were less in the laparoscopic group. The size of tumors removed by open surgery was larger than by laparoscopy (8 vs. 4 cm; P = 0.003). No locoregional recurrences are reported so far in the laparoscopic group. CONCLUSIONS Laparoscopic adrenalectomy is both feasible and safe for some malignant tumors of the adrenal gland in experienced hands. However, it cannot be applied to all cases. Careful selection, preoperative staging, and respect for oncologic principles are important considerations in choosing laparoscopic surgery for primary and secondary adrenal malignancy. Short-term outcomes are better when the laparoscopic approach is possible. Confirmation and long-term results with further studies are required.
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Affiliation(s)
- Boris Kirshtein
- Department of Surgery "A," Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Outcomes of laparoscopic adrenalectomy. Clinical experience with 68 patients. Surg Oncol 2007; 17:49-57. [PMID: 17949973 DOI: 10.1016/j.suronc.2007.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 07/16/2007] [Accepted: 09/12/2007] [Indexed: 11/24/2022]
Abstract
The aim of this study was to analyze feasibility and outcomes of laparoscopic adrenalectomy (LA). Pathology, size and bilateral site of lesions were considered. Between December 1998 and May 2007 in our institution a total of 68 patients of mean age of 53 years underwent unilateral (n=57) or bilateral (n=11) LA. Adrenal masses averaged 5.4cm in size (range 1.2-13cm) and 56.7g in weight (range 10-265) including 71 benign and 8 malignant lesions. A total of 79 adrenal glands were resected, 44 right sided and 35 left sided. Removal was complete in 77 cases and partial (sparing adrenalectomy) in 1 patient affected by bilateral pheochomocytoma. Three left adrenalectomies for pheochromocytoma were robot-assisted. The transperitoneal lateral approach was preferred and the posterior retroperitoneal approach was adopted in 5 patients. The mean duration of surgery for each LA was 138+/-90min and 3.8 trocar were used on average (range 3-6). Conversion was needed in 3 cases owing to difficult dissection of large masses. Estimated mean blood loss for each LA was 95+/-30ml and it was greater for bilateral LA. Mortality was nil and morbidity was 5.8%. The average length of hospital stay (LOS) in surgical unit was 4+/-2.4 days (range 2-8). Patients affected by hormone secreting or bilateral lesions, by unilateral or bilateral pheochromocytoma and by bilateral Cushing's disease were transferred to the endocrinological ward so that their overall hospital stay was prolonged to 9+/-2.8 days on average (range 7-17). Mean duration of follow-up of patients was 38 months (range 2-100) and demonstrated acceptable endocrine results. Three primary cortical carcinomas were discovered as chance findings on histologic examination. While long-term results after LA for cortical carcinomas were poor and LA is not recommended in such cases, long-term results after LA for adrenal metastases were encouraging.
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Liatsikos EN, Papathanassiou Z, Voudoukis T, Repanti M, Sklavou C, Filos KS, Stolzenburg JU, Athanasopoulos A, Perimenis P, Barbalias GA. Case report: laparoscopic adrenalectomy in a patient with primary adrenal malignant melanoma. J Endourol 2006; 20:123-6. [PMID: 16509796 DOI: 10.1089/end.2006.20.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report a case of laparoscopic management of a primary malignant melanoma of the left adrenal gland. A 42-year-old male presented a 55 x 60-mm round, inhomogeneous, noninvasive mass of the left adrenal gland. Hormone-activity values were within normal range. The mass was removed laparoscopically en bloc along with the left adrenal gland, and its histopathologic evaluation was consistent with the features of a malignant melanocytic tumor. Postoperatively, the patient presented no signs of fever or remarkable blood loss and was discharged on the third day in good clinical condition. He is free of disease 1 year later.
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