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Bletsis P, Akgun E, Romero-Velez G, La Riva A, Berber E. A Comparison of Near-Infrared Autofluorescence Findings in Benign Versus Malignant Adrenal Tumors. Ann Surg Oncol 2024; 31:5122-5127. [PMID: 38802716 PMCID: PMC11236849 DOI: 10.1245/s10434-024-15430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/24/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Many adrenal tumors are deemed radiologically indeterminate and surgically removed. Adrenal tissue, like parathyroid glands, exhibits near-infrared autofluorescence (NIRAF) properties. This study was designed to investigate the potential of NIRAF to differentiate benign versus malignant adrenal tumors. METHODS Patients undergoing adrenalectomy between October 2021 and May 2023 were prospectively studied. Adrenalectomy specimens were inspected with NIRAF imaging. Specimen autofluorescence (AF) characteristics were recorded. Comparisons were made between different tumor types and a logistic regression model was constructed to differentiate benign versus malignant tumors. A receiver operating characteristic curve was used to identify an optimal AF threshold differentiating benign versus malignant tumors. RESULTS A total of 108 adrenal specimens were examined: adrenocortical adenomas/other benign lesions (n = 72), pheochromocytomas (n = 18), adrenocortical neoplasms of uncertain behavior (n = 4), and malignant tumors (n = 14). A significant difference in normalized AF intensity was identified when comparing adrenocortical adenomas (3.08 times background) with pheochromocytomas (1.95, p = 0.001) and malignant tumors (1.11, p < 0.0001). The Area Under the Curve differentiating benign vs malignant tumors was 0.87, with an optimal normalized AF threshold at 1.93. CONCLUSIONS Different adrenal pathologies exhibit diverse AF properties. These findings suggest a potential intraoperative utility of NIRAF in predicting benign versus malignant nature for radiologically indeterminate adrenal tumors.
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Affiliation(s)
- Panagiotis Bletsis
- Department of Endocrine Surgery, Metabolism and Endocrinology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ege Akgun
- Department of Endocrine Surgery, Metabolism and Endocrinology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gustavo Romero-Velez
- Department of Endocrine Surgery, Metabolism and Endocrinology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Anibal La Riva
- Department of Endocrine Surgery, Metabolism and Endocrinology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Metabolism and Endocrinology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
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2
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Mongardini FM, Paolicelli M, Catauro A, Conzo A, Flagiello L, Nesta G, Esposito R, Ronchi A, Romano A, Patrone R, Docimo L, Conzo G. Outcomes and Follow-Up Trends in Adrenal Leiomyosarcoma: A Comprehensive Literature Review and Case Report. J Clin Med 2024; 13:3499. [PMID: 38930027 PMCID: PMC11204854 DOI: 10.3390/jcm13123499] [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: 04/01/2024] [Revised: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Leiomyosarcoma (LMS) originating from the adrenal gland is exceedingly rare, constituting a minute fraction of soft tissue sarcomas. Due to its rarity, with less than 50 documented cases in English medical literature, the diagnosis and management of adrenal LMS remain challenging. The aim of this study was to perform a review of the literature, in order to evaluate the prognosis of these rare cancers and report our specific case. Methods: A systematic review of the literature was conducted using PubMed, Web of Science, Google Scholar, and Scopus databases, up to December 2020. The search utilized MeSH terms such as "Adrenal Gland Neoplasms," "Leiomyosarcoma," "Adrenalectomy," and "Smooth Muscle Tumor." The inclusion criteria focused on studies reporting patients with a histopathological diagnosis of adrenal leiomyosarcoma. The PRISMA guidelines were followed to ensure a comprehensive analysis. Results: Out of 63 identified studies, 43 met the inclusion criteria and were reviewed. These studies highlighted the rarity and aggressive behavior of adrenal leiomyosarcoma. Surgical excision remains the cornerstone of treatment, often complemented by adjuvant therapies. The reviewed case involved a 52-year-old woman who underwent a right laparoscopic adrenalectomy for a 9 × 7 × 6 cm grade 3 leiomyosarcoma. Despite subsequent adjuvant chemotherapy, hepatic metastases were detected, illustrating the aggressive nature of the disease. The literature underscores the importance of histopathological analysis and long-term surveillance for managing disease progression. Conclusions: Optimal management of adrenal leiomyosarcoma requires a multidisciplinary approach and meticulous follow-up. The rarity of the disease poses challenges for standardizing treatment, but surgical excision and tailored adjuvant therapies show promise. Further research is essential to refine treatment strategies and improve prognosis for this rare malignancy.
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Affiliation(s)
- Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Maddalena Paolicelli
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Antonio Catauro
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Alessandra Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Luigi Flagiello
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Giusiana Nesta
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Rosetta Esposito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Andrea Ronchi
- Division of Pathology, Department of Mental Health and Preventive Medicine, Luigi Vanvitelli University of Campania, 80138 Naples, Italy;
| | - Alessandro Romano
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Renato Patrone
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy;
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
| | - Giovanni Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (A.C.); (A.C.); (L.F.); (G.N.); (R.E.); (A.R.); (L.D.); (G.C.)
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Mandelia A, Mayilvaganan S, Naik PB, Kanneganti P. Laparoscopic Transperitoneal Adrenalectomy for Adrenal Tumors in Children: Technical Considerations and Surgical Experience. J Laparoendosc Adv Surg Tech A 2024; 34:189-198. [PMID: 37862564 DOI: 10.1089/lap.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Aims: This study aimed to review our surgical experience of laparoscopic adrenalectomy (LA) for adrenal masses in the pediatric age group. Materials and Methods: The electronic medical records of all patients younger than 18 years of age who underwent LA between 2016 and 2023 were retrospectively reviewed. Children with adrenal tumors localized to the site of origin without evidence of encasement of major vasculature or involvement of adjacent organs were considered for LA. Patients with diagnosis of malignant adrenal tumor on preoperative work-up underwent open adrenalectomy. Data were collected regarding demography, clinical presentation, hormonal workup, imaging, duration of surgery, transfusion requirement, conversion rate, postoperative recovery, duration of intravenous (i.v.) analgesia and hospital stay, pathology, complications, and status at follow-up. Results: Between 2016 and 2023, LA adrenalectomy was performed in 11 patients (6 boys and 5 girls) with a mean age of 46.3 (8-120) months. A functional tumor was detected in 6 (54.5%) children, manifesting clinically with Cushing's syndrome (3), virilization (1), feminization (1), or Conn's syndrome (1). Seven (63.6%) tumors originated from the right adrenal, and 4 (36.4%) from the left adrenal gland. The mean tumor weight and size was 49.1 (10-80) g and 5.6 (3-8) cm, respectively. Histopathology included adrenal adenoma (5), ganglioneuroma (3), ganglioneuroblastoma (1), myelolipoma (1), and intermediate adrenocortical tumor (1). The mean surgery duration was 186.6 (120-265) minutes. Intraoperative blood transfusion was required in 2 (18.2%) patients and none required conversion. Full feeds were resumed at 42.7 (24-60) hours, i.v. analgesia requirement was for 54.5 (36-72) hours and mean hospital stay was 5.1 (3-8) days. All patients were symptom-free with no recurrence at mean follow-up period of 50.6 (3-83) months. Conclusions: In children with well-circumscribed, localized, and noninvasive adrenal tumors, LA is feasible, effective, and safe with all advantages of minimally invasive surgery.
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Affiliation(s)
- Ankur Mandelia
- Department of Pediatric Surgery and Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Sabaretnam Mayilvaganan
- Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Prathibha B Naik
- Department of Pediatric Surgery and Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Pujana Kanneganti
- Department of Pediatric Surgery and Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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Cheng Y, Zhu Y. Comparison of Perioperative Outcomes Between Laparoscopic and Robot-Assisted Adrenalectomy for Large Pheochromocytoma (≥ 5cm): A Retrospective Study. Cancer Manag Res 2023; 15:1207-1216. [PMID: 37937145 PMCID: PMC10625893 DOI: 10.2147/cmar.s435791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
Purpose The objective of this study was to compare perioperative outcomes in patients with large (≥5cm) pheochromocytomas who underwent adrenalectomy. Patients and Methods We retrospectively reviewed patients who underwent laparoscopic adrenalectomy (LA) and robot-assisted adrenalectomy (RA) for large pheochromocytoma (≥ 5cm) at our center between January 2015 to February 2023. We compared the perioperative outcomes between the two groups and investigated impact of high Nor-Metanephrine (NMN) levels on perioperative outcomes by analyzing this subgroup. Results A total of 115 patients were included in the study, with 48 patients in the robotic group and 67 patients in the laparoscopic group. The following significant difference were identified in favor of RA: shorter operative (excluding docking time) time (190.0 vs 220.0 min, p=0.002), lower estimated blood loss (50.0 vs 120.0 mL, p=0.013), however, RA group has higher surgical expenses (37933.0 vs 7936.0 CNY, p< 0.001). This finding remained consistent when analyzing patients with high NMN levels. Conclusion Patients with large pheochromocytoma may experience reduced blood loss and shorter operative time when undergoing robot-assisted adrenalectomy. However, it is important to note that the RA approach is associated with significantly higher costs.
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Affiliation(s)
- Yuling Cheng
- Department of Urology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yu Zhu
- Department of Urology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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Kiriakopoulos A, Giannakis P, Menenakos E. Pheochromocytoma: a changing perspective and current concepts. Ther Adv Endocrinol Metab 2023; 14:20420188231207544. [PMID: 37916027 PMCID: PMC10617285 DOI: 10.1177/20420188231207544] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
This article aims to review current concepts in diagnosing and managing pheochromocytoma and paraganglioma (PPGL). Personalized genetic testing is vital, as 40-60% of tumors are linked to a known mutation. Tumor DNA should be sampled first. Next-generation sequencing is the best and most cost-effective choice and also helps with the expansion of current knowledge. Recent advancements have also led to the increased incorporation of regulatory RNA, metabolome markers, and the NETest in PPGL workup. PPGL presentation is highly volatile and nonspecific due to its multifactorial etiology. Symptoms mainly derive from catecholamine (CMN) excess or mass effect, primarily affecting the cardiovascular system. However, paroxysmal nature, hypertension, and the classic triad are no longer perceived as telltale signs. Identifying high-risk subjects and diagnosing patients at the correct time by using appropriate personalized methods are essential. Free plasma/urine catecholamine metabolites must be first-line examinations using liquid chromatography with tandem mass spectrometry as the gold standard analytical method. Reference intervals should be personalized according to demographics and comorbidity. The same applies to result interpretation. Threefold increase from the upper limit is highly suggestive of PPGL. Computed tomography (CT) is preferred for pheochromocytoma due to better cost-effectiveness and spatial resolution. Unenhanced attenuation of >10HU in non-contrast CT is indicative. The choice of extra-adrenal tumor imaging is based on location. Functional imaging with positron emission tomography/computed tomography and radionuclide administration improves diagnostic accuracy, especially in extra-adrenal/malignant or familial cases. Surgery is the mainstay treatment when feasible. Preoperative α-adrenergic blockade reduces surgical morbidity. Aggressive metastatic PPGL benefits from systemic chemotherapy, while milder cases can be managed with radionuclides. Short-term postoperative follow-up evaluates the adequacy of resection. Long-term follow-up assesses the risk of recurrence or metastasis. Asymptomatic carriers and their families can benefit from surveillance, with intervals depending on the specific gene mutation. Trials primarily focusing on targeted therapy and radionuclides are currently active. A multidisciplinary approach, correct timing, and personalization are key for successful PPGL management.
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Affiliation(s)
- Andreas Kiriakopoulos
- Department of Surgery, ‘Evgenidion Hospital’, National and Kapodistrian University of Athens School of Medicine, 5th Surgical Clinic, Papadiamantopoulou 20 Str, PO: 11528, Athens 11528, Greece
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Gan L, Peng L, Meng C, Zheng L, Zeng Z, Ge S, Wang Z, Li K, Li Y. The role of laparoscopic adrenalectomy in the treatment of large pheochromocytomas (>6 cm): a meta-analysis and systematic review. Int J Surg 2023; 109:1459-1469. [PMID: 37037515 PMCID: PMC10389469 DOI: 10.1097/js9.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The effectiveness and safety of laparoscopic adrenalectomy (LA) under different routes for the treatment of large pheochromocytomas (PCCs) is unknown. MATERIALS AND METHODS This meta-analysis and systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Three databases were systematically searched, including Medline, PubMed, and Web of Science. The time frame of the search was set from the creation of the database to October 2022. Perioperative outcomes were divided into two groups according to tumor size: SMALL group (≤6 cm in diameter), LARGE group (>6 cm in diameter). RESULTS Eight studies including 600 patients were included. In the LA group, complications was comparable in both groups (SMALL group and LARGE group), and the LARGE group had longer operative time [OT weighted mean difference (WMD)=32.55; 95% CI: 11.17, 53.92; P <0.01], length of stay (LOS WMD=0.82; 95% CI: 0.19, 1.44; P <0.05), more estimated blood loss (EBL WMD=85.26; 95% CI: 20.71, 149.82; P <0.05), hypertension [odds ratio (OR)=3.99; 95% CI: 1.84, 8.65; P <0.01], hypotension (OR=1.84; 95% CI: 1.11, 3.05; P <0.05), and conversion (OR=5.60; 95% CI: 1.56, 20.13; P <0.01). In the transabdominal LA group, OT, LOS, EBL, complications, hypertension, and hypotension were the same in both groups. In the retroperitoneal LA group, complications and hypotension were the same in both groups, while the LARGE group had longer OT (WMD=52.07; 95% CI: 26.95, 77.20; P <0.01), LOS (WMD=0.51; 95% CI: 0.00, 1.01; P <0.05), more EBL (WMD=92.99; 95% CI: 27.70, 158.28; P <0.01) and higher rates of hypertension (OR=6.03; 95% CI: 1.95, 18.61; P <0.01). CONCLUSIONS LA remains a safe and effective approach for large PCC. Transabdominal LA is superior to retroperitoneal LA.
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Affiliation(s)
- Lijian Gan
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
| | - Lei Peng
- Department of Urology, The Second Hospital of Lanzhou University Medical School, Lanzhou, Gansu Province, China
| | - Chunyang Meng
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
| | - Lei Zheng
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
| | - Zhiqiang Zeng
- Department of Urology, Affiliated Hospital of Southwest Medical University
- Department of Urology, Nanchong Central Hospital, Nanchong, Sichuan Province
| | - Si Ge
- Department of Urology, Affiliated Hospital of Southwest Medical University
- Department of Urology, Nanchong Central Hospital, Nanchong, Sichuan Province
| | - Zuoping Wang
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
| | - Kangsen Li
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
| | - Yunxiang Li
- Department of Urology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University)
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Hou Q, Zhang B, Liu J, Luo Y, Shang P. Clinical Efficacy Analysis of Different Surgical Methods for Giant Adrenal Tumors (≥10 cm): A Single-Center Study of 44 Cases. J Laparoendosc Adv Surg Tech A 2023. [PMID: 37093026 DOI: 10.1089/lap.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Objective: The objective of this study was to compare the efficacy and safety of open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) by summarizing the clinical features and treatment experience of giant adrenal tumors. Methods: The clinical data of 44 patients with adrenal tumors ≥10 cm admitted to the Second Hospital of Lanzhou University from January 2006 to August 2022 were retrospectively analyzed. The mean tumor diameter was 11.6 ± 1.8 cm. Regular follow-up was performed to observe the outcome of symptoms and the recurrence after operation. Results: All the 44 patients successfully completed the operation and were divided into the OA group (21 cases) and the LA group (11 cases of transabdominal laparoscopic adrenalectomy [TLA] and 12 cases of retroperitoneal laparoscopic adrenalectomy [RLA]) according to different operation methods. The analysis results showed that the proportion of estimated blood loss (EBL) >100 mL and the postoperative length of stay (PLOS) in the LA group were superior to those in the OA group, and there were no significant differences in other surgical indicators (P > .05); subgroup analysis was conducted for patients in the LA group according to different surgical pathways, and the results showed that there were no significant differences in each surgical indicator between TLA and RLA (P > .05). Among the 44 patients, 15 (34.1%) had intraoperative complications, 19 (43.2%) had postoperative complications, and 5 (21.7%) were converted from LA to OA. The median follow-up time was 68 (5-162) months. Conclusions: For adrenal tumors with diameter ≥10 cm, both LA and OA have relatively large damage to the patients, and the incidence of conversion to open surgery is also high. However, LA is superior to OA in EBL and PLOS. Given the fact that giant adrenal tumors are mainly pheochromocytoma and paraganglioma and have an increased possibility of malignancy, we suggest that the relationship between tumors and peripheral important blood vessels and organs should be carefully evaluated before operation, and the operative methods should be selected according to the experience of the surgeon.
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Affiliation(s)
- Qian Hou
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Biao Zhang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Juanyao Liu
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Yao Luo
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Panfeng Shang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
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Xue R, Hu C, Zheng Z, Wei L, Yuan X, Lyu X, Shen P, Li J, Cao X. Renal‑rotation techniques in retroperitoneoscopic adrenalectomy for giant pheochromocytomas: a clinical intervention study with historical controls. BMC Urol 2023; 23:47. [PMID: 36991447 DOI: 10.1186/s12894-023-01221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Dealing with the giant pheochromocytomas (maximum diameter ≥ 6 cm) has long been a tough challenge for urologists. We introduced a new retroperitoneoscopic adrenalectomy method modified with renal-rotation techniques to treat giant pheochromocytomas. METHODS 28 diagnosed patients were prospectively recruited as the intervention group. Meanwhile, by referring to the historical records in our database, matched patients who had undergone routine retroperitoneoscopic adrenalectomy (RA), transperitoneal laparoscopic adrenalectomy (TA), or open adrenalectomy (OA) for giant pheochromocytomas were selected as controls. Perioperative and follow-up data were collected for comparative assessment. RESULTS Among all the groups, the intervention group had the minimal bleeding volume (28.93 ± 25.94 ml, p < 0.05), the least intraoperative blood pressure variation (59.11 ± 25.68 mmHg, p < 0.05), the shortest operation time (115.32 ± 30.69 min, p < 0.05), the lowest postoperative ICU admission rates (7.14%, p < 0.05), and shortest drainage time length (2.57 ± 0.50 days, p < 0.05). Besides, compared with TA and OA groups, intervention group was also characterized by lower pain scores (3.21 ± 0.63, p < 0.05), less postoperative complications (p < 0.05), earlier diet initiation time (1.32 ± 0.48 postoperative days, p < 0.05) and ambulation time (2.68 ± 0.48 postoperative days, p < 0.05). Follow-up blood pressure and metanephrine and normetanephrine levels in all intervention group patients remained normal. CONCLUSION Compared with RA, TA, and OA, retroperitoneoscopic adrenalectomy with renal-rotation techniques is a more feasible, efficient, and secure surgical treatment for giant pheochromocytomas. TRIAL REGISTRATION This study has been prospectively registered on the Chinese Clinical Trial Registry website (ChiCTR2200059953, date of first registration: 14/05/2022).
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Affiliation(s)
- Ruizhi Xue
- Urology Department, The First Hospital of Shanxi Medical University, Jiefang South Road, Taiyuan, Shanxi, 030000, China
| | - Caoyang Hu
- Urology Department, The First Hospital of Shanxi Medical University, Jiefang South Road, Taiyuan, Shanxi, 030000, China
| | - Zhongyi Zheng
- Urology Department, The First Hospital of Shanxi Medical University, Jiefang South Road, Taiyuan, Shanxi, 030000, China
| | - Liang Wei
- Urology Department, The First Hospital of Shanxi Medical University, Jiefang South Road, Taiyuan, Shanxi, 030000, China
| | - Xiaobin Yuan
- Urology Department, The First Hospital of Shanxi Medical University, Jiefang South Road, Taiyuan, Shanxi, 030000, China
| | - Xiao Lyu
- Urology Department, The First Hospital of Shanxi Medical University, Jiefang South Road, Taiyuan, Shanxi, 030000, China
| | - Pengliang Shen
- Urology Department, The First Hospital of Shanxi Medical University, Jiefang South Road, Taiyuan, Shanxi, 030000, China
| | - Jun Li
- Urology Department, The First Hospital of Shanxi Medical University, Jiefang South Road, Taiyuan, Shanxi, 030000, China
| | - Xiaoming Cao
- Urology Department, The First Hospital of Shanxi Medical University, Jiefang South Road, Taiyuan, Shanxi, 030000, China.
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Tan Z, Fu S, Wang H, Wang J. A commentary on ‘Safety and effectiveness of minimally invasive adrenalectomy versus open adrenalectomy in patients with large adrenal tumors (≥5 cm): a meta-analysis and systematic review’. Int J Surg 2023; 109:493-494. [PMID: 37093076 PMCID: PMC10389187 DOI: 10.1097/js9.0000000000000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 04/09/2023]
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10
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Dogrul AB, Cennet O, Dincer AH. Minimally invasive techniques in benign and malignant adrenal tumors. World J Clin Cases 2022; 10:12812-12821. [PMID: 36569018 PMCID: PMC9782958 DOI: 10.12998/wjcc.v10.i35.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Minimally invasive adrenalectomy has become the main treatment modality for most adrenal lesions. Both laparoscopic transabdominal and retroperitoneoscopic approaches are safe and feasible options, each with respective advantages, including better surgical outcomes, fewer complications, and faster recovery over open adrenalectomy. While open surgery remains a valid modality in treatment of adrenocortical cancer in the presence of some findings such as invasion, robotic platforms, and minimally invasive surgery have gained popularity as technology continues to evolve. Organ preservation during adrenalectomy is feasible in some conditions to prevent adrenal insufficiency. Ablative technologies are increasingly utilized in benign and malignant tumors, including the adrenal gland, with various outcomes. A multidisciplinary team, an experienced surgeon, and a high-volume center are recommended for any surgical approaches and management of adrenal lesions. This review article evaluated recent findings and current evidence on minimally invasive adrenalectomy.
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Affiliation(s)
- Ahmet Bulent Dogrul
- Department of General Surgery, Hacettepe University Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
| | - Omer Cennet
- Department of General Surgery, Hacettepe University Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
| | - Anıl Hilmi Dincer
- Department of General Surgery, Hacettepe University Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
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