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Hue JJ, Alvarado C, Bachman K, Wilhelm SM, Ammori JB, Towe CW, Rothermel LD. Outcomes of malignant pheochromocytoma based on operative approach: A National Cancer Database analysis. Surgery 2021; 170:1093-1098. [PMID: 33958205 DOI: 10.1016/j.surg.2021.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Malignant pheochromocytoma is often managed with adrenalectomy. Most literature focusing on postoperative outcomes are from single institutions. This study aimed to describe outcomes of adrenalectomy for malignant pheochromocytoma using a national database. We hypothesized that minimally invasive approaches might be associated with improved short-term outcomes but potentially inferior oncologic efficacy. METHODS Patients who underwent adrenalectomy for malignant pheochromocytoma were identified in the National Cancer Database (2010-2016). Patients were categorized as minimally invasive adrenalectomy or open adrenalectomy. Short- and long-term outcomes were compared. RESULTS A total of 276 patients underwent adrenalectomy for malignant pheochromocytoma: 50.7% open adrenalectomy and 49.3% minimally invasive adrenalectomy. Demographics were similar, except those who underwent open adrenalectomy had larger tumors compared to minimally invasive adrenalectomy (8.2 cm vs 4.7 cm; P < .001). Tumor size ≥6 cm was associated with a reduced likelihood of minimally invasive adrenalectomy (relative to open adrenalectomy) on multivariable regression (odds ratio = 0.23; P < .001). Open adrenalectomy was associated with longer duration of stay relative to minimally invasive adrenalectomy (6 vs 3 days; P < .001). Rates of positive margins, unplanned readmissions, or 30-/90-day mortalities were similar based on operative approach. Five-year survival rates were similar (open adrenalectomy 74.3%, minimally invasive adrenalectomy 79.1%). There was no association between overall survival and operative approach on multivariable Cox analysis when controlling for tumor size, laterality, and clinicodemographic variables. CONCLUSION Patients with larger malignant pheochromocytomas were more likely to undergo an open adrenalectomy. With the exception of an increased duration of stay, there was no difference in short- or long-term postoperative outcomes. These data suggest that minimally invasive adrenalectomy appears safe among tumors <6 cm.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, University Hospitals Cleveland Medical Center, OH. https://twitter.com/jj_hue
| | - Christine Alvarado
- Department of Surgery, University Hospitals Cleveland Medical Center, OH. https://twitter.com/calvaradomd
| | - Katelynn Bachman
- Department of Surgery, University Hospitals Cleveland Medical Center, OH
| | - Scott M Wilhelm
- Department of Surgery, University Hospitals Cleveland Medical Center, OH
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, OH. https://twitter.com/ammorijohn
| | - Christopher W Towe
- Department of Surgery, University Hospitals Cleveland Medical Center, OH
| | - Luke D Rothermel
- Department of Surgery, University Hospitals Cleveland Medical Center, OH.
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2
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Lee JH, Chai YJ, Kim TH, Choi JY, Lee KE, Kim HY, Yoon YS, Kim HH. Clinicopathological Features of Ganglioneuroma Originating From the Adrenal Glands. World J Surg 2017; 40:2970-2975. [PMID: 27431319 DOI: 10.1007/s00268-016-3630-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ganglioneuromas are benign tumors that rarely develop from adrenal glands. In this study, we present our clinical experience of patients with adrenal ganglioneuroma (AGN). METHODS Demographic, diagnostic, surgical, and pathologic findings of patients who were adrenalectomized as a result of AGN were retrospectively reviewed from the database of a tertiary referral hospital. RESULTS Among 1784 patients who underwent an adrenalectomy between 2002 and 2015, 35 (1.9 %; 14 males, 21 females) were diagnosed with AGN. Mean age was 33.4 ± 18.7 years (0-84). Twenty-nine (82.9 %) were asymptomatic, four (11.4 %) complained of abdominal discomfort, and two (5.7 %) had abdominal distension. Preoperative computed tomography (CT) reported AGN in 22 (62.9 %) cases. Precontrast Hounsfield units, increased postcontrast phase attenuation, and well-defined borders were characteristic CT features of AGN. Mean tumor size was 6.3 ± 3.3 cm (range, 1.5-16.0). No recurrence occurred during a median follow-up period of 19 months (range, 1-120). CONCLUSION AGN was asymptomatic in most cases and diagnosis may be challenging. Adrenalectomy is a safe treatment modality for AGN and ensures favorable outcomes when diagnosed.
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Affiliation(s)
- Joon-Hyop Lee
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Young Jun Chai
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Radiology, Seoul National University Hospital and College of Medicine, 101 Daeak-ro, Jongno-gu, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
- Department of Surgery, Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea.
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital and College of Medicine, 101 Daeak-ro, Jongno-gu, Seoul, Korea
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3
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Mylonas KS, Schizas D, Economopoulos KP. Adrenal ganglioneuroma: What you need to know. World J Clin Cases 2017; 5:373-377. [PMID: 29085827 PMCID: PMC5648998 DOI: 10.12998/wjcc.v5.i10.373] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/14/2017] [Accepted: 07/10/2017] [Indexed: 02/05/2023] Open
Abstract
Adrenal ganglioneuromas (GNs) constitute rare, differentiated tumors which originate from neural crest cells. GNs are usually hormonally silent and tend to be discovered incidentally on imaging tests. Adrenalectomy is the gold standard for the treatment of primary adrenal GNs. Nevertheless, preoperative differential diagnosis of GNs remains extremely challenging, and thus histopathological examination is required in order to confirm the diagnosis of GN. Overall, prognosis after surgical resection seems to be excellent, without any recurrences or need for adjuvant therapy.
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Affiliation(s)
- Konstantinos S Mylonas
- Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
- Surgery Working Group, Society of Junior Doctors, 11852 Athens, Greece
| | - Dimitrios Schizas
- Surgery Working Group, Society of Junior Doctors, 11852 Athens, Greece
- First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Konstantinos P Economopoulos
- Surgery Working Group, Society of Junior Doctors, 11852 Athens, Greece
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
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4
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Schietroma M, Pessia B, Stifini D, Lancione L, Carlei F, Cecilia EM, Amicucci G. Effects of low and standard intra-abdominal pressure on systemic inflammation and immune response in laparoscopic adrenalectomy: A prospective randomised study. J Minim Access Surg 2016; 12:109-17. [PMID: 27073301 PMCID: PMC4810942 DOI: 10.4103/0972-9941.178513] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND: The advantages of laparoscopic adrenalectomy (LA) over open adrenalectomy are undeniable. Nevertheless, carbon dioxide (CO2) pneumoperitoneum may have an unfavourable effect on the local immune response. The aim of this study was to compare changes in the systemic inflammation and immune response in the early post-operative (p.o.) period after LA performed with standard and low-pressure CO2 pneumoperitoneum. MATERIALS AND METHODS: We studied, in a prospective randomised study, 51 patients consecutively with documented adrenal lesion who had undergone a LA: 26 using standard-pressure (12-14 mmHg) and 25 using low-pressure (6-8 mmHg) pneumoperitoneum. White blood cells (WBC), peripheral lymphocyte subpopulation, human leucocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin (IL)-6 and IL-1, and C-reactive protein (CRP) were investigated. RESULTS: Significantly higher concentrations of neutrophil elastase, IL-6 and IL-1 and CRP were detected p.o. in the standard-pressure group of patients in comparison with the low-pressure group (P < 0.05). A statistically significant change in HLA-DR expression was recorded p.o. at 24 h, as a reduction of this antigen expressed on the monocyte surface in patients from the standard group; no changes were noted in low-pressure group patients (P < 0.05). CONCLUSIONS: This study demonstrated that reducing the pressure of the pneumoperitoneum to 6-8 mmHg during LA reduced p.o. inflammatory response and averted p.o. immunosuppression.
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Affiliation(s)
| | - Beatrice Pessia
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | - Derna Stifini
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | - Laura Lancione
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
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Tiberio GAM, Solaini L, Arru L, Merigo G, Baiocchi GL, Giulini SM. Factors influencing outcomes in laparoscopic adrenal surgery. Langenbecks Arch Surg 2013; 398:735-43. [DOI: 10.1007/s00423-013-1082-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 04/14/2013] [Indexed: 11/30/2022]
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6
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Perysinakis I, Marakaki C, Avlonitis S, Katseli A, Vassilatou E, Papanastasiou L, Piaditis G, Zografos GN. Laparoscopic adrenalectomy in patients with subclinical Cushing syndrome. Surg Endosc 2013; 27:2145-8. [PMID: 23355146 DOI: 10.1007/s00464-012-2730-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 12/04/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Subclinical Cushing syndrome in patients with adrenal incidentalomas has been associated with an increased prevalence of the metabolic syndrome and cardiovascular risk. The management of these patients, be it conservative or surgical, is still debated, but there is accumulating evidence that surgery is best and that laparoscopic adrenalectomy, when possible, is the most preferred procedure. Here we present the short- and long-term results of laparoscopic adrenalectomy for subclinical Cushing syndrome and determine the effect of this procedure on components of the metabolic syndrome. METHODS Twenty-nine patients, 8 men and 21 women with adrenal incidentalomas and subclinical Cushing syndrome who underwent laparoscopic adrenalectomy, were studied retrospectively. They had undergone postoperative follow-up for improvement or worsening of their arterial blood pressure, body weight, and fasting glucose level for a mean period of 77 months. RESULTS Preoperatively, 17 patients (58.6 %) had arterial hypertension, 14 (48.3 %) had a body mass index exceeding 27 kg/m(2), and 12 (41.4 %) had diabetes mellitus. Postoperatively, a decrease in mean arterial pressure was found in 12 patients (70.6 %), a decrease in body mass index in 6 patients (42.9 %), and an improvement in glycemic control in 5 patients (41.7 %). CONCLUSIONS Laparoscopic adrenalectomy is beneficial in many patients with subclinical Cushing syndrome because it reduces arterial blood pressure, body weight, and fasting glucose levels. Prospective randomized studies are needed to compare laparoscopic adrenalectomy with a conservative approach and to confirm these results.
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Affiliation(s)
- Iraklis Perysinakis
- 3rd Department of Surgery, George Gennimatas General Hospital of Athens, Athens, Greece.
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7
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Ali JM, Liau SS, Gunning K, Jah A, Huguet EL, Praseedom RK, Jamieson NV. Laparoscopic adrenalectomy: Auditing the 10 year experience of a single centre. Surgeon 2012; 10:267-72. [DOI: 10.1016/j.surge.2011.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/13/2011] [Accepted: 08/15/2011] [Indexed: 01/01/2023]
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8
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[Bilateral laparoscopic adrenalectomy due to a phaeochromocytoma in Von Hippel-Lindau syndrome: a technique with 4 trocars]. Cir Esp 2012; 92:137-9. [PMID: 22591617 DOI: 10.1016/j.ciresp.2012.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 01/04/2012] [Accepted: 01/29/2012] [Indexed: 11/23/2022]
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9
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He HC, Dai J, Shen ZJ, Zhu Y, Sun FK, Shao Y, Zhang RM, Wang HF, Rui WB, Zhong S. Retroperitoneal adrenal-sparing surgery for the treatment of Cushing's syndrome caused by adrenocortical adenoma: 8-year experience with 87 patients. World J Surg 2012; 36:1182-1188. [PMID: 22382766 DOI: 10.1007/s00268-012-1509-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The objective of this study was to present our 8-year experience with partial adrenalectomy via the retroperitoneal approach for the treatment of Cushing's adenoma. METHODS A total of 93 patients who underwent adrenal surgery for Cushing's adenoma from March 2003 to December 2010 were enrolled in this study. Preoperative, intraoperative, and postoperative variables were reviewed from the database. Student's t test was used to analyze the continuous data, and the χ(2) test was used to analyze the categoric data. A value of p < 0.05 was considered statistically significant. RESULTS Adrenal-sparing surgery was performed in 87 cases (31 by open surgery, 56 by retroperitoneal laparoscopy). Six patients underwent open/laparoscopic total adrenalectomy because of recurrent disease or a large size. The cure rate in our series was 97.8%. Hypertension resolved in 34 of 64 patients (53.1%), diabetes in 7 of 27 patients (25.9%) and obesity in 28 of 48 patients (58.3%). One patient died during the postoperative period. The intraoperative complication rate for the open surgery group was significantly higher than that for the retroperitoneal laparoscopy group (9.1 vs. 1.7%). CONCLUSIONS The retroperitoneal approach is reliable and safe for treating Cushing's syndrome. The laparoscopic technique can decrease the prevalence of intraoperative complications. Retroperitoneal laparoscopic partial adrenalectomy can be performed with extremely low morbidity and achieves an excellent outcome, although death may occur during the postoperative period in high-risk patients. Postoperative management plays an important role in the surgical treatment of Cushing's syndrome.
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Affiliation(s)
- Hong-Chao He
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jun Dai
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Zhou-Jun Shen
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Yu Zhu
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Fu-Kang Sun
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Yuan Shao
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Rong-Ming Zhang
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Hao-Fei Wang
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Wen-Bin Rui
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
| | - Shan Zhong
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, No. 197 Ruijin Er Road, Shanghai, 200025, China
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Rizek P, Gorecki P, Lindenmayer A, Moktan S. Laparoscopic adrenalectomy for bilateral metachronous aldosteronomas. JSLS 2011; 15:100-4. [PMID: 21902953 PMCID: PMC3134682 DOI: 10.4293/108680811x13071180407230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aldosterone-producing adenoma can present months to years after adrenalectomy in the contralateral adrenal gland. Laparoscopic adrenalectomy may be the procedure of choice for this pathology. Introduction: Primary aldosteronism affects 5% to 13% of patients with hypertension. Idiopathic bilateral hyperplasia (IHA) and unilateral aldosterone-producing adenoma (APA) are the most common types of primary aldosteronism. Bilateral APA is a very rare entity with only a few reports in the literature. We present the case of a patient with metachronous bilateral APA treated with metachronous bilateral total and near total adrenalectomy. Case Report: A 66-year-old female was evaluated for hypokalemia and hypertension refractory to medical therapy 2 years after laparoscopic adrenalectomy for right APA. Follow-up abdominal CT scan revealed a new 1.1-cm left adrenal mass. The patient underwent a laparoscopic near total adrenalectomy for her new left adrenal mass. Pathology examination revealed a new APA. The operation and the patient's postoperative course were uneventful. Potassium levels were normalized and her hypertension became well controlled. Conclusion: APA can present metachronously months to years after adrenalectomy for APA in the contralateral adrenal gland. Laparoscopic adrenalectomy remains the approach of choice for this pathology.
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Affiliation(s)
- Philippe Rizek
- Department of Surgery, New York Methodist Hospital, Brooklyn, New York 11215, USA
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11
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Bergamini C, Martellucci J, Tozzi F, Valeri A. Complications in laparoscopic adrenalectomy: the value of experience. Surg Endosc 2011; 25:3845-51. [DOI: 10.1007/s00464-011-1804-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 05/19/2011] [Indexed: 12/13/2022]
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12
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Koning JL, Nicolay LI, Jellison F, Heldt JP, Dunbar JA, Baldwin DD. Ocular Complications After Open and Hand-assisted Laparoscopic Donor Nephrectomy. Urology 2011; 77:92-6. [DOI: 10.1016/j.urology.2010.03.084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Revised: 02/28/2010] [Accepted: 03/16/2010] [Indexed: 11/28/2022]
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13
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Posterior retroperitoneoscopic adrenalectomy for clinical and subclinical Cushing's syndrome. World J Surg 2010; 34:1391-7. [PMID: 20143066 DOI: 10.1007/s00268-010-0453-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Because of co-morbidity, adrenalectomy for adrenal Cushing's syndrome may be associated with an increased complication rate and long operating times. In the present study we report our experience with the posterior retroperitoneoscopic adrenalectomy in a large group of patients with clinical or subclinical Cushing's syndrome. PATIENTS AND METHODS Between July 1994 and June 2009, 170 patients (17 males, 153 females age 50 +/- 13 years; range: 12-78 years) affected by Cushing's syndrome underwent operation via posterior retroperitoneoscopic access. Patients were divided into two groups, those with manifest Cushing's syndrome (mCS) [99 patients: 6 male, 93 female; age 45 +/- 13 years] and those with subclinical Cushing's syndrome (sCS) [71 patients: 11 male, 60 female; age: 56 +/- 11 years]. The sCS classification was assumed in cases without typical clinical symptoms but with a pathological dexamethasone suppression test. Partial adrenalectomy was performed in 35 cases (24 in the mCS-group and 11 in the sCS-group). RESULTS Mortality was zero; major complications did not occur. The incidence of postoperative minor complications was 5.3%. Mean operating time was 58 +/- 36 min (range: 20-230 min) and did not differ between mCS and sCS patients (58 versus 59 min; p = ns). Postoperative oral steroids supplementation (POSS) was administered in 136 patients (99 mCS, 37 sCS). If POSS was started, mean duration of therapy was 12.3 months (mCS) and 10.3 months (sCS) [p = 0.08], respectively. After a mean follow-up of 70.9 +/- 46.5 months the cure rate was 99.4%. CONCLUSIONS The posterior retroperitoneoscopic approach is fast and safe even in patients with Cushing's syndrome. Partial adrenalectomy represents a new option in the treatment of cortisol-producing adenomas.
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Schreinemakers JMJ, Kiela GJ, Valk GD, Vriens MR, Rinkes IHMB. Retroperitoneal endoscopic adrenalectomy is safe and effective. Br J Surg 2010; 97:1667-72. [DOI: 10.1002/bjs.7191] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
The aim of this study was to review an experience with retroperitoneal endoscopic adrenalectomy (REA). This is the procedure of choice for adrenal tumours at this institution.
Methods
Between 1997 and 2008, 112 REAs were performed in a single university centre. Data were retrieved retrospectively from a prospectively collected database, including information on patient demographics, surgical procedure, complications and hospital stay.
Results
One hundred and twelve REAs were carried out successfully in 105 patients, including seven bilateral adrenalectomies. Thirty-nine patients with unilateral adrenal disease had a phaeochromocytoma, of whom 16 had multiple endocrine neoplasia syndrome type 2, 21 patients had Cushing's disease and 20 had Conn's disease. Median body mass index was 27 (interquartile range 23–29) kg/m2. The median duration of unilateral operations was 100 (90–130) min with a median blood loss of 5 ml. Median tumour size was 3·1 (2·0–4·4) cm. Conversion from REA to open surgery was needed in two patients. Seven patients experienced postoperative complications (2 major, 5 minor). One patient needed a reoperation. The median postoperative hospital stay was 3 days. A learning curve with a significant decrease in operating time was observed over the years.
Conclusion
REA appears to be a safe and effective surgical technique for adrenal gland tumours up to 6 cm in diameter, with a minimal complication rate.
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Affiliation(s)
- J M J Schreinemakers
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - G J Kiela
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - G D Valk
- Department of Endocrinology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M R Vriens
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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15
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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.
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Affiliation(s)
- Dimitrios Linos
- 1st Surgical Clinic, Diagnostic and Therapeutic Center of Athens Hygeia, Athens, Greece.
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16
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Guerrieri M, Campagnacci R, Patrizi A, Romiti C, Arnaldi G, Boscaro M. Primary adrenal hypercortisolism: minimally invasive surgical treatment or medical therapy? A retrospective study with long-term follow-up evaluation. Surg Endosc 2010; 24:2542-6. [PMID: 20336323 DOI: 10.1007/s00464-010-1000-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 01/29/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Because the most suitable management of subclinical Cushing syndrome (SCS, which involves hypersecretion of cortisol without clinically evident disease) still is undefined, the current study aimed to compare retrospectively the outcome for a cohort of patients treated by medical therapy or laparoscopic adrenalectomy (LA). METHODS Over a 12-year period, 47 patients with SCS have been treated by means of LA (19 patients, group A) or medical therapy (28 patients, group B). Group A consisted of 15 women and 4 men with a mean age of 54.8 years. Eight patients had a left adrenal mass, whereas nine had a right adrenal mass, and one patient had bilateral lesion. Group B was composed of 18 women and 10 men with a mean age of 57.8 years. Of these patients, 14 had a left adrenal lesion, 12 had a right adrenal lesion, and 1 had bilateral lesion. The patients were followed up for a mean 4 years (range, 1-11 years) by both an endocrinologist and a surgeon. RESULTS In group A, hypertension improved for 66.3% of the patients; body mass index (BMI) decreased for 47.4%; and hyperlipidemia based on high-density lypoproteins (HDL) cholesterol, total cholesterol ratio, and triglyceridemic concentration improved for 63.2% of the patients. No changes in bone parameters were seen after surgery in SCS patients with osteoporosis. Some patients in group B, during their long-term medical therapy, experienced worsening hypertension (14.2%), hyperlipidemia (17.8%), and diabetes mellitus (8%). CONCLUSIONS This retrospective study focused on a cohort of patients with SCS. Their medium long-term follow-up evaluation showed that LA is better than medical therapy for treating this condition, especially by reducing the cardiovascular risk (hypertension-hyperlipidemia).
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Affiliation(s)
- Mario Guerrieri
- Clinica di Chirurgia Generale e Metodologia Chirurgica, Università Politecnica delle Marche-Ospedali Riuniti, via Conca 1, 60121, Ancona, Italy
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Meyer-Rochow GY, Soon PSH, Delbridge LW, Sywak MS, Bambach CP, Clifton-Bligh RJ, Robinson BG, Sidhu SB. Outcomes of minimally invasive surgery for phaeochromocytoma. ANZ J Surg 2009; 79:367-70. [PMID: 19566519 DOI: 10.1111/j.1445-2197.2009.04891.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Laparoscopic adrenalectomy is now accepted as the procedure of choice for the resection of benign adrenocortical tumours, but few studies have assessed whether the outcomes of laparoscopic adrenalectomy for adrenal phaeochromocytoma are similar to that of other adrenal tumour types. This is a retrospective cohort study. Clinical and operative data were obtained from an adrenal tumour database and hospital records. A total of 191 patients had laparoscopic adrenalectomy, of which 36 were for phaeochromocytoma, over a 12-year period. Length of hospital stay (4.8 vs 3.6 days, P= 0.03) and total operating times (183 vs 157 min, P= 0.01) were greater in the laparoscopic phaeochromocytoma resection group. Despite the greater size of the phaeochromocytomas compared to the remaining adrenal tumour types (44 mm vs 30 mm, P < 0.01), however, rate of conversion and morbidity were no different. Laparoscopic adrenalectomy for phaeochromocytoma is a safe procedure with similar outcomes to laparoscopic adrenalectomy for other adrenal tumour types.
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Affiliation(s)
- Goswin Y Meyer-Rochow
- Cancer Genetics, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, St Leonards, NSW 2065, Australia.
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