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Hayashida M, Sakaguchi K, Yasuoka S, Tanaka M, Oshina T, Oka S, Tatsushima K, Takeshita A, Takeuchi Y, Urakami S. Perirenal fat thickness is a powerful predictor for surgical outcomes of transperitoneal laparoscopic adrenalectomy. Int J Urol 2024; 31:56-63. [PMID: 37750454 DOI: 10.1111/iju.15307] [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: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES Laparoscopic adrenalectomy has been the gold standard surgical procedure. However, the adaptation criteria for malignant tumors and predictors of perioperative outcomes are not well defined. Therefore, this study tried to identify valid predictors for perioperative outcomes of laparoscopic adrenalectomy and consider the adaptation criteria. METHODS We retrospectively reviewed the preoperative and perioperative data of 216 patients who underwent transperitoneal laparoscopic adrenalectomy in our hospital. Preoperative factors associated with perioperative outcomes were analyzed using multiple regression analysis. RESULTS Among 216 patients, 165 (76.4%), 26 (12.0%), and 25 (11.6%) were suspected of having benign tumors, pheochromocytoma, and malignant tumors, respectively. Median tumor size was 25.0 mm (interquartile range 18.0-35.0); median perirenal fat thickness was 9.2 mm (interquartile range 4.9-15.6) on preoperative computed tomography scans. The median operative time was 145.5 min (interquartile range 117.5-184.0) and the median estimated blood loss was 0.0 mL (interquartile range 0.0-27.3). Perirenal fat thickness (p < 0.001), tumor size (p < 0.001), and malignant tumors (p = 0.020) were associated with operative time, and perirenal fat thickness (p = 0.038) and malignant tumors (p = 0.002) were associated with estimated blood loss. CONCLUSIONS Perirenal fat thickness, tumor size, and malignant tumors are valid predictors of the surgical outcomes of transperitoneal laparoscopic adrenalectomy. As only perirenal fat thickness is associated with both surgical outcomes except for malignant tumors, it is a powerful predictor. Transperitoneal laparoscopic adrenalectomy for large malignant adrenal tumors with thick perirenal fat should be performed with caution.
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Affiliation(s)
| | | | | | - Makoto Tanaka
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | | | - Suguru Oka
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | - Keita Tatsushima
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Akira Takeshita
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Yasuhiro Takeuchi
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
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2
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Donlon P, Dennedy MC. Thermal ablation in adrenal disorders: a discussion of the technology, the clinical evidence and the future. Curr Opin Endocrinol Diabetes Obes 2021; 28:291-302. [PMID: 33741778 PMCID: PMC8183491 DOI: 10.1097/med.0000000000000627] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland. RECENT FINDINGS Observational evidence has demonstrated the benefit of thermal ablation in (i) resolving adrenal endocrinopathy arising from benign adenomas, (ii) treating solitary metastases to the adrenal and (iii) controlling metastatic adrenocortical carcinoma and phaeochromocytoma/paraganglioma. SUMMARY Microwave thermal ablation offers a promising, minimally invasive therapeutic modality for the management of functioning adrenocortical adenomas and adrenal metastases. Appropriate technological design, treatment planning and choice of imaging modality are necessary to overcome technical challenges associated with this emerging therapeutic approach.
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Affiliation(s)
- Padraig Donlon
- Adrenal Research Laboratory, The Discipline of Pharmacology and Therapeutics, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Ireland
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Cho JW, Lee YM, Sung TY, Yoon JH, Chung KW, Hong SJ. Factors related to improved clinical outcomes associated with adrenalectomy for metachronous adrenal metastases from solid primary carcinomas. Surg Oncol 2018; 27:18-22. [PMID: 29549899 DOI: 10.1016/j.suronc.2017.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/21/2017] [Accepted: 11/18/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgery for metachronous adrenal metastases from solid primary carcinoma has increased with the development of technical skills. Here we analyzed the postoperative clinical outcomes of patients who underwent adrenalectomy for metachronous adrenal metastases from solid primary carcinomas. METHODS Patients who underwent adrenalectomy for metachronous adrenal metastases after initial treatment of primary carcinoma at Asan Medical Center from 2000 to 2010 were included. Clinicopathological parameters were analyzed to evaluate prognostic outcomes. RESULTS A total of 30 patients with 19 hepatocellular carcinomas and 11 lung carcinomas were included. The mean age was 54.3 years. The mean time until adrenalectomy was 23 months. The size of the metastatic adrenal tumor and the disease status of the primary carcinoma at the time of adrenalectomy were associated with second recurrence after adrenalectomy (P < 0.05). There was no significant difference in disease-specific recurrence-free survival between patients who underwent open adrenalectomy and laparoscopic adrenalectomy (P = 0.646). CONCLUSIONS Surgical treatment should be recommended for metachronous adrenal metastases in patients with no evidence of primary carcinoma and/or in those having metastatic adrenal tumors ≤4.4 cm. This approach may increase the recurrence-free interval related to second recurrence. Further, laparoscopic adrenalectomy appears sufficient for the treatment of such patients.
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Affiliation(s)
- Jae Won Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Jong Ho Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Puccini M, Panicucci E, Candalise V, Ceccarelli C, Neri CM, Buccianti P, Miccoli P. The role of laparoscopic resection of metastases to adrenal glands. Gland Surg 2017; 6:350-354. [PMID: 28861375 DOI: 10.21037/gs.2017.03.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The potential role of the laparoscopic approach for metastases to the adrenal gland is debated. We review here a series of patients consecutively submitted to laparoscopic adrenalectomy (LA) for suspected adrenal metastasis (AM). METHODS Retrospective study (consecutive series) of LA for AM. We measured parameters associated to primary tumor and metastasis. Statistical analysis: stepwise regression model. RESULTS Thirty-seven LA were performed on 36 patients. The mean age was 62.1 yrs. The side was right in 13 cases. Primary tumor was in the lung (n=22), breast (n=4), colon-rectum (n=4), kidney (n=3), thyroid, melanoma and ovary (n=1 each). Thirty-three out of 37 were confirmed to be AM (mean diameter 50 mm). Twenty-five were single metastasis. One LA was converted due to cava vein infiltration. Mean operative time was 142 min', median p.o. hospital stay was 3 days. After a mean follow-up of 33 months, 9 patients (25%) were alive free of disease, 6 (17%) were alive with disease. Mean post-adrenalectomy DFI was 19 months (range, 0-97 months), and it was the most predictive variable for survival (P<0.001). CONCLUSIONS The dimensions and absence of invasion on imaging, the evolutive status of the disease and the performance status of the patient are key factors for LA, which is associated with adequate oncologic results, a quicker postoperative recovery, and potential survival benefits.
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Affiliation(s)
- Marco Puccini
- Department of Surgery, University of Pisa, Pisa, Italy
| | - Erica Panicucci
- Department of Experimental Pathology, University of Pisa, Pisa, Italy
| | | | | | | | | | - Paolo Miccoli
- Department of Surgery, University of Pisa, Pisa, Italy
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5
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Barmpari ME, Savvidis C, Dede AD, Markogiannakis H, Dikoglou C, Xekouki P, Stratakis CA, Andreas M, Malaktari-Skarantavou S. Adrenal malignant melanoma masquerading as a pheochromocytoma in a patient with a history of a multifocal papillary and medullary thyroid carcinoma. Hormones (Athens) 2016; 15:283-290. [PMID: 27376430 PMCID: PMC6354246 DOI: 10.14310/horm.2002.1653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Adrenal masses usually represent benign and nonfunctional adrenal adenomas; however, primary or metastatic malignancy should also be considered. Discovery of an adrenal mass needs further evaluation in order to exclude malignancy and hormonal secretion. We present a rare case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma. CASE REPORT A 61-year-old male farmer was referred for evaluation of a mass in the right supraclavicular region and a left adrenal lesion. The patient had a history of a multifocal papillary and medullary thyroid carcinoma. Laboratory tests revealed increased 24hour urinary dopamine and also increased serum calcitonin and neuron specific enolase. A pathology report of the resected right supraclavicular mass and left adrenal showed a malignant melanoma. CONCLUSION This is a case of a possibly primary adrenal malignant melanoma with imaging and biochemical features of a pheochromocytoma. Although this case is very rare and there are rigid diagnostic criteria for the diagnosis of primary adrenal melanoma, it underlines the fact that the differential diagnosis of a dopamine secreting adrenal mass should include primary or metastatic malignant melanoma in order to determine the best diagnostic approach for the patient and select the most appropriate surgical management.
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Affiliation(s)
- Maria E Barmpari
- Department of Endocrinology and Metabolism, Hippokration Hospital, Athens, Greece.
| | - Christos Savvidis
- Department of Endocrinology and Metabolism, Hippokration Hospital, Athens, Greece
| | - Anastasia D Dede
- Department of Endocrinology and Metabolism, Hippokration Hospital, Athens, Greece
| | - Haridimos Markogiannakis
- Department of Endocrine Surgery, First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Athens, Greece
| | | | - Paraskevi Xekouki
- Section of Endocrinology and Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Constantine A Stratakis
- Section of Endocrinology and Genetics, Program on Developmental Endocrinology Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Manouras Andreas
- Department of Endocrine Surgery, First Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Athens, Greece
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Desai A, Rai H, Haas J, Witten M, Blacksburg S, Schneider JG. A Retrospective Review of CyberKnife Stereotactic Body Radiotherapy for Adrenal Tumors (Primary and Metastatic): Winthrop University Hospital Experience. Front Oncol 2015; 5:185. [PMID: 26347852 PMCID: PMC4538288 DOI: 10.3389/fonc.2015.00185] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022] Open
Abstract
The adrenal gland is a common site of cancer metastasis. Surgery remains a mainstay of treatment for solitary adrenal metastasis. For patients who cannot undergo surgery, radiation is an alternative option. Stereotactic body radiotherapy (SBRT) is an ablative treatment option allowing larger doses to be delivered over a shorter period of time. In this study, we report on our experience with the use of SBRT to treat adrenal metastases using CyberKnife technology. We retrospectively reviewed the Winthrop University radiation oncology data base to identify 14 patients for whom SBRT was administered to treat malignant adrenal disease. Of the factors examined, the biological equivalent dose (BED) of radiation delivered was found to be the most important predictor of local adrenal tumor control. We conclude that CyberKnife-based SBRT is a safe, non-invasive modality that has broadened the therapeutic options for the treatment of isolated adrenal metastases.
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Affiliation(s)
- Amishi Desai
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
| | - Hema Rai
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
| | - Jonathan Haas
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
| | - Matthew Witten
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
| | - Seth Blacksburg
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
| | - Jeffrey G Schneider
- Department of Hematology and Oncology, Winthrop University Hospital , Mineola, NY , USA
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Kandathil A, Wong KK, Wale DJ, Zatelli MC, Maffione AM, Gross MD, Rubello D. Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature. Endocrine 2015; 49:6-26. [PMID: 25273320 DOI: 10.1007/s12020-014-0440-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 09/25/2014] [Indexed: 12/12/2022]
Abstract
PET/CT with (18)F-fluorodeoxyglucose (FDG) or using different radiocompounds has proven accuracy for detection of adrenal metastases in patients undergoing cancer staging. It can assist the diagnostic work-up in oncology patients by identifying distant metastases to the adrenal(s) and defining oligometastatic disease that may benefit from targeted intervention. In patients with incidentally discovered adrenal nodules, so-called adrenal "incidentaloma" FDG PET/CT is emerging as a useful test to distinguish benign from malignant etiology. Current published evidence suggests a role for FDG PET/CT in assessing the malignant potential of an adrenal lesion that has been 'indeterminately' categorized with unenhanced CT, adrenal protocol contrast-enhanced CT, or chemical-shift MRI. FDG PET/CT could be used to stratify patients with higher risk of malignancy for surgical intervention, while recommending surveillance for adrenal masses with low malignant potential. There are caveats for interpretation of the metabolic activity of an adrenal nodule on PET/CT that may lead to false-positive and false-negative interpretation. Adrenal lesions represent a wide spectrum of etiologies, and the typical appearances on PET/CT are still being described, therefore our goal was to summarize the current diagnostic strategies for evaluation of adrenal lesions and present metabolic and anatomic appearances of common and uncommon adrenal lesions. In spite of the emerging role of PET/CT to differentiate benign from malignant adrenal mass, especially in difficult cases, it should be emphasized that PET/CT is not needed for most patients and that many diagnostic problems can be resolved by CT and/or MR imaging.
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Affiliation(s)
- Asha Kandathil
- Nuclear Medicine/Radiology Department, University of Michigan Hospital, Ann Arbor, MI, 48109, USA
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8
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Ball MW, Allaf ME. Robot-Assisted Adrenalectomy (Total, Partial, & Metastasectomy). Urol Clin North Am 2014; 41:539-47. [DOI: 10.1016/j.ucl.2014.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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[Adrenalectomy for adrenal metastases: is the laparoscopic approach beneficial for all patients?]. Prog Urol 2014; 24:1069-75. [PMID: 25242339 DOI: 10.1016/j.purol.2014.08.236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/29/2014] [Accepted: 08/19/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Laparoscopy has become the gold-standard approach for excision of benign adrenal tumors but the question of its safety for malignant lesions is still controversial. Our aim was to evaluate the oncologic outcome of laparoscopic adrenalectomy for adrenal metastasis and to look for predictors of a negative surgical outcome. PATIENTS AND METHODS We retrospectively reviewed the charts of all patients who underwent laparoscopic adrenalectomy for suspicion of adrenal metastasis between 2007 and 2013 at a single academic institution. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Univariate analysis was performed to determine risk factors of negative surgical outcome (positive surgical margins, complications, conversion, significant blood loss) and predictors of RFS and CSS. RESULTS Thirteen patients underwent 14 laparoscopic adrenalectomies. All patients were operated by a single highly experienced surgeon. Complications occurred in 2 patients (15%): 2 blood transfusions (Clavien-score=2). There were 3 positive surgical margins (21%). Mean length of hospital stay was 4.3 days. Unadjusted RFS and CSS were respectively 48.4% and 83.3% at 1 year, 39.5% and 66.7% at 5 years. In univariate analysis, tumor size was the only risk factor of complication (P=.009) and conversion (P=0.009). Capsule invasion and tumor size were risk factors of positive surgical margins (P=0.01 and P<0.0001). One hundred percent of complications, conversion and positive surgical margins occurred in tumor>7.5 cm on preoperative CT-scan. No predictors of RFS and CSS was found in univariate analysis. CONCLUSION Laparoscopic adrenalectomy for adrenal metastasis achieves good surgical and oncologic outcomes. When performed by highly experienced surgeon, complications and positive surgical margins occur only in tumors>7.5 cm. These patients may benefit from an open surgical approach.
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10
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Riedinger CB, Tobert CM, Lane BR. Laparoendoscopic single site, laparoscopic or open surgery for adrenal tumors: Selecting the optimal approach. World J Clin Urol 2014; 3:54-65. [DOI: 10.5410/wjcu.v3.i2.54] [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: 12/05/2013] [Revised: 03/07/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, current indications for open surgical adrenalectomy (OS-A), minimally-invasive adrenalectomy (MI-A), and laparoendoscopic single-site adrenalectomy (LESS-A) remain unclear. A comprehensive English-language literature review was performed using MEDLINE/PubMED to identify articles and guidelines pertinent to the surgical management of adrenal tumors. A comprehensive chart review was performed for three illustrative cases. Clinical recommendations were generated based on relevant literature and the expertise of the investigator group. MI-A offers advantages over OS-A in properly selected patients, who experience fewer complications, lower blood loss, and shorter hospital stays. Robot-assisted laparoscopic and retroperitoneoscopic adrenalectomy may offer advantages over transperitoneal surgery, and LESS-A may be an even less-invasive option that will require further evaluation. MI-A remains the surgical treatment of choice for most adrenal lesions. Tumor size and stage are the primary indications for selecting alternative treatment modalities. OS-A remains the gold standard for large tumors (> 10 cm) and suspected or known advanced stage malignancy. LESS-A appears to be an appropriate initial approach for small tumors (< 4-5 cm), including pheochromocytoma and isolated adrenal metastases.
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11
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Chen L, Wang D, Mao W, Huang X, He C. A Case of Long-term Survival after Curative Resection for Synchronous Solitary Adrenal Metastasis from Rectal Cancer. Pak J Med Sci 2014; 30:216-9. [PMID: 24639864 PMCID: PMC3955575 DOI: 10.12669/pjms.301.4341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/10/2013] [Accepted: 10/22/2013] [Indexed: 12/04/2022] Open
Abstract
Clinically curable adrenal metastasis is rare. We report a case of synchronous solitary adrenal metastasis from rectal cancer in a 51-year-old man who underwent curative resection. A right adrenal mass was found by ultrasonography during his routine physical examination and this was confirmed by computed tomography (CT). His serum carcinoembryonic antigen (CEA) level was found elevated, and colonoscopy revealed a rectal tumor located 10cm from anal verge. A simultaneous laparoscopic right adrenalectomy and anterior resection for rectal carcinoma was performed. Histopathological examination revealed well-differentiated rectal adenocarcinoma with adrenal metastasis. The patient is still alive and free from disease 6 years after the surgery. A review in the literature showed that synchronous solitary adrenal metastasis from colorectal carcinoma is very rare. Surgical resection and for selected patients, laparoscopic procedure may provide survival benefit and potential surgical cure for a solitary metastasis.
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Affiliation(s)
- Linlin Chen
- Linlin Chen, MD, Department of Colorectal Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China
| | - Da Wang
- Da Wang, MD, Department of Colorectal Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China
| | - Weifang Mao
- Weifang Mao, MD, Department of Colorectal Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China
| | - Xuefeng Huang
- Xuefeng Huang, MD, Department of Colorectal Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China
| | - Chao He
- Chao He, Professor, Department of Colorectal Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China
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12
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Synchronous adrenal metastasis and an inferior vena cava tumor thrombus from an ovarian carcinoma. J Ovarian Res 2014; 7:5. [PMID: 24418397 PMCID: PMC3895845 DOI: 10.1186/1757-2215-7-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 01/10/2014] [Indexed: 12/03/2022] Open
Abstract
A 60-year-old woman presented with synchronous adrenal metastasis and an inferior vena cava tumor thrombus in the adrenal vein that developed from an ovarian carcinoma. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and right adrenalectomy with caval tumor thrombectomy for treatment. Microscopic examination revealed a clear cell ovarian carcinoma and a metastatic adrenal tumor. The patient is clinically free of disease after 6 years of follow-up. There have been no reports of synchronous adrenal metastasis with an inferior vena cava thrombus that developed from an ovarian carcinoma. As several reports have described the long-term survival after adrenalectomy for the treatment of isolated adrenal metastasis, clinicians should be aware of this potential occurrence so that patients can be appropriately treated.
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Hirayama T, Fujita T, Koguchi D, Nishi M, Kurosaka S, Tsumura H, Tabata KI, Iwamura M. Laparoscopic adrenalectomy for metastatic adrenal tumor. Asian J Endosc Surg 2014; 7:43-7. [PMID: 24251723 DOI: 10.1111/ases.12076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/22/2013] [Accepted: 10/02/2013] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Treating adrenal metastases from primary malignancies with laparoscopic adrenalectomy (LA) remains controversial. The aim of this study was to evaluate the feasibility, effectiveness and efficiency of LA for solitary adrenal metastasis. METHODS From November 2003 to September 2012, eight consecutive patients with adrenal metastasis were treated with LA. A retrospective study was conducted, and clinical and histological data were analyzed. RESULTS All LA were successfully performed. There were no major complications, blood transfusions or conversions to open adrenalectomy. The patients included seven men and one woman with a median age of 59 years at the time of operation. Adrenal metastases were most commonly noted to be from non-small-cell lung cancer (four patients) and renal cell carcinoma (four patients). The majority of adrenal metastases were unilateral (right: one patient; left: seven patients). One patient had bilateral metastases. The median overall survival was 14 months. Four patients (two with non-small-cell lung cancer; two with renal cell carcinoma) were alive with no evidence of metastatic disease as of October 2013. CONCLUSION LA is a safe and effective procedure for patients with isolated metastases. Surgical resection with LA for a solitary adrenal metastasis from primary malignancy can achieve a good prognosis.
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Affiliation(s)
- Takahiro Hirayama
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
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14
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Simutis G, Lengvenis G, Beiša V, Strupas K. Endoscopic retroperitoneal adrenalectomy for adrenal metastases. Int J Endocrinol 2014; 2014:806194. [PMID: 25276132 PMCID: PMC4170751 DOI: 10.1155/2014/806194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/20/2014] [Accepted: 08/05/2014] [Indexed: 12/13/2022] Open
Abstract
Objectives. To evaluate whether retroperitoneal approach for adrenalectomy is a safe and effective treatment for adrenal metastases (AM). Methods. From June 2004 to January 2014, nine consecutive patients with AM were treated with endoscopic retroperitoneal adrenalectomy (ERA). A retrospective study was conducted, and clinical data, tumor characteristics, and oncologic outcomes were acquired and analyzed. Results. Renal cancer was the primary site of malignancy in 44.4% of cases. The mean operative time was 132 ± 10.4 min. There were 5 synchronous and 4 metachronous AM. One patient required conversion to transperitoneal laparoscopic procedure. No mortality or perioperative complications were observed. The median overall survival was 11 months (range: 2-42 months). Survival rates of 50% and 25% were identified at 1 and 3 years, respectively. At the end of the study, 4 patients were alive with a mean observed follow-up of 20 months. No patients presented with local tumor relapse or port-site metastases. Conclusions. This study shows that ERA is a safe and effective procedure for resection of AM and advances the surgical treatment of adrenal disease. The use of the retroperitoneal approach for adrenal tumors less than 6 cm can provide very favorable surgical outcomes.
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Affiliation(s)
- Gintaras Simutis
- Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Faculty of Medicine, Vilnius University, Santariškiu 2, 08661 Vilnius, Lithuania
- *Gintaras Simutis:
| | - Givi Lengvenis
- Faculty of Medicine, Vilnius University, M.K.Čiulionio 21, 03101 Vilnius, Lithuania
| | - Virgilijus Beiša
- Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Faculty of Medicine, Vilnius University, Santariškiu 2, 08661 Vilnius, Lithuania
| | - Kęstutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Center of Abdominal Surgery, Faculty of Medicine, Vilnius University, Santariškiu 2, 08661 Vilnius, Lithuania
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15
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Bradley CT, Strong VE. Surgical management of adrenal metastases. J Surg Oncol 2013; 109:31-5. [PMID: 24338382 DOI: 10.1002/jso.23461] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/10/2013] [Indexed: 12/15/2022]
Abstract
In the presence of a history of cancer, adrenal masses are commonly, but not exclusively, metastases. Depending upon the status of the patient's ongoing cancer therapy, overall tumor burden, and performance score, adrenalectomy is a viable treatment option. Herein we review the prevalence, diagnostic evaluation, and selection for surgical treatment of adrenal metastases. Additional attention is paid to recent data supporting the safety and oncologic efficacy of laparoscopic adrenalectomy.
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Affiliation(s)
- Ciarán T Bradley
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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16
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Stefanidis D, Goldfarb M, Kercher KW, Hope WW, Richardson W, Fanelli RD. SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc 2013; 27:3960-80. [PMID: 24018761 DOI: 10.1007/s00464-013-3169-z] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/02/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Dimitrios Stefanidis
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, CMC Surgical Specialty Center, Suite 300, 1025 Morehead Medical Plaza, Charlotte, NC, 28204, USA,
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Modified anatomical retroperitoneoscopic adrenalectomy for adrenal metastatic tumor: technique and survival analysis. Surg Endosc 2012; 27:992-9. [PMID: 23239289 DOI: 10.1007/s00464-012-2553-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/14/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND In a previous experience, anatomical retroperitoneoscopic adrenalectomy (ARA) was proven safe, effective, and technically efficient for surgical adrenal diseases. However, laparoscopic adrenalectomy for adrenal metastasis is controversial. We evaluated the safety, effectiveness, and efficiency of modified ARA technique for adrenal metastasis and predicted survival factors. METHODS From 2000 to 2010, a consecutive series of 75 patients with adrenal metastases underwent 78 ARAs (three bilateral ARAs). Three modifications and one key procedure were specified in this study. Medical records and follow-up data were retrospectively studied. Then, the surgery data of ARA were compared with those of other approaches to evaluate its safety, effectiveness, and efficiency. Additionally, univariate and multivariate analyses were used to predict the risk factors for survival. RESULTS The most common primary tumor was renal cell carcinoma (RCC, n = 26), followed by non-small-cell lung carcinoma (NSCLC, n = 23), and hepatocellular carcinoma (HCC, n = 12). A total of 76 successful ARAs and two conversions to open surgery were performed, with a median operation time of 53 (range, 40-250) min and median estimated blood loss of 25 (range, 10-700) mL. The local recurrence rate was 5.3 %, and the median survival was 24 months. These data were comparable with or even better than other approaches in previous studies. The independent prognostic factors of survival were body mass index (BMI, p < 0.001), tumor type (p < 0.001), tumor size (≥ 4 cm vs. <4 cm, p = 0.017), and margin status (negative vs. positive, p = 0.011). CONCLUSIONS ARA is a safe and effective approach for the management of adrenal metastasis in selected patients. BMI, tumor type, tumor size, and margin status may independently predict survival.
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[Laparoscopic adrenalectomy for isolated metastasis of adrenal glands]. Nihon Hinyokika Gakkai Zasshi 2012; 103:535-9. [PMID: 22876657 DOI: 10.5980/jpnjurol.103.535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The treatment of adrenal metastases using laparoscopic surgery still remains a matter of considerable controversy. The aim of this study is to present our experience of laparoscopic adrenalectomy for isolated adrenal metastasis. METHODS From June 2004 to June 2011, 5 adults (4 males/1 female) with isolated metastases to the adrenal glands underwent laparoscopic adrenalectomy. These patients included 3 cases of lung carcinoma, a case of hepatocellular carcinoma, and a case of renal cell carcinoma. The median patient age was 69 (range 61 to 72), and the median tumor size was 3.5 cm (range 2.5 to 7.0). RESULTS Laparoscopic adrenalectomies were performed without any complications using transperitoneal and retroperitoneal approaches. The median operative time was 142 minutes (range 126 to 174), and the estimated blood loss was 38 ml (range 25 to 158). The resection margins were free in all cases. A patient with lung cancer has been treated with adjuvant chemotherapy, otherwise, 4 patients have not. Regarding the oncological outcome, 3 of 5 patients were alive without any recurrence at a median follow-up of 14 months. About the rest two cases, one was alive with lung metastasis occurred at 15 months later, the other was died of the cancer at 14 months later. CONCLUSIONS Laparoscopic adrenalectomy for isolated adrenal metastasis is thought to be feasible. However, the indication of the surgery must be determined depending on tumor size, cancer characteristics, risk factors and so on. Additionally, the operative procedures such as approaches must be discussed sufficiently.
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Zerrweck C, Caiazzo R, Clerquin B, Donatini G, Lamblin A, Khatib ZE, Arnalsteen L, Carnaille B, Pattou F. Renal Origin and Size are Independent Predictors of Survival After Surgery for Adrenal Metastasis. Ann Surg Oncol 2012; 19:3621-6. [DOI: 10.1245/s10434-012-2464-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Indexed: 11/18/2022]
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de la Quintana Basarrate A, Martínez Fernández G, Arana González A, Prieto M, Alvarez I, Martínez Indart L, García González JM, Perdigo Bilbao LF, Colina Alonso A. [Surgical treatment of adrenal gland metastases: results in a series of 35 patients]. Cir Esp 2012; 90:634-40. [PMID: 22726448 DOI: 10.1016/j.ciresp.2012.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 04/24/2012] [Accepted: 04/26/2012] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The objectives of this study are to present the results of adrenalectomies due to metastasis, and to analyse the prognostic factors that may help to predict long-term survival in this patient group. PATIENTS AND METHODS A retrospective study was conducted on 35 patients who underwent adrenalectomy for metastases in the Hospital de Cruces from 1996 to January 2010. The survival analysis was performed using the Kaplan and Meier method. RESULTS Non-small cell lung cancer (NSCLC) was the most frequent primary tumour, with 18 cases. In 15 patients the diagnosis of adrenal metastasis was synchronous with the primary tumour, and in 20 cases it was metachronous. Only 7 patients survived without disease for 12, 22, 26, 58, 60, 65 and 120 months after the adrenalectomy. The disease free survival at 5 years was 16% in the whole series, and 27% in the NSCLC sub-group. None of the prognostic factors evaluated (size greater than 4.5 cm, cell type, differentiation grade, chemotherapy, surgical technique, disease free interval) was statistically significant in the overall survival, either in the general series or in the sub-group of patients with NSCLC. However, in the general series with tumour recurrence, the difference in survival between metachronous and synchronous metastasis was statistically significant (P=.05), in favour of the former. CONCLUSIONS Adrenalectomy improves the expected survival particularly in patients with NSCLC. Patients with metachronous metastases do not have a higher rate of disease free survival at 5 years than those with synchronous metastases, although they do have a longer survival with the disease. When there is tumour recurrence, it is usually early.
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Rees GJ, Britton DC, Malcolm GP, Rees M. Surgery for widely disseminated breast cancer: prolonged control by excision of metastases. JRSM SHORT REPORTS 2012; 3:26. [PMID: 22715427 PMCID: PMC3375843 DOI: 10.1258/shorts.2012.011162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Gareth Jg Rees
- Bath Clinic , Claverton Down Road, Combe Down, Bath, BA2 7BR , UK
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Sancho JJ, Triponez F, Montet X, Sitges-Serra A. Surgical management of adrenal metastases. Langenbecks Arch Surg 2011; 397:179-94. [DOI: 10.1007/s00423-011-0889-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022]
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Crenn G, Delaunay B, Salloum A, Vezzosi D, Bellec L, Thoulouzan M, Bennet A, Rischmann P, Plante P, Caron P, Soulie M, Huyghe E. Résultats de la chirurgie des métastases surrénaliennes par voie laparoscopique. Prog Urol 2011; 21:607-14. [DOI: 10.1016/j.purol.2011.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 02/05/2011] [Accepted: 03/29/2011] [Indexed: 11/25/2022]
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Castillo OA, Foneron A, Vidal-Mora I, Sánchez-Salas R, Vitagliano G, Díaz M. Bilateral simultaneous laparoscopic adrenalectomy for congenital adrenal hyperplasia: initial experience. J Pediatr Urol 2011; 7:174-7. [PMID: 20580317 DOI: 10.1016/j.jpurol.2010.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Accepted: 05/11/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Congenital adrenal hyperplasia (CAH) is an uncommon syndrome which represents a therapeutic challenge. We analyzed the role of bilateral simultaneous laparoscopic adrenalectomy in the management of CAH. MATERIAL AND METHODS : Between October 2004 and September 2006, three female patients underwent bilateral simultaneous laparoscopic adrenalectomy for CAH. Data were retrospectively collected. Variables analyzed were persistence of CAH clinical signs, variations in 17 OH progesterone level and corticoid medication, operative time, median blood loss, postoperative pain, hospital stay, and body image perception after surgery. RESULTS Median age was 16.3 years. Complete regression of virilization signs, acne and hyperpigmentation was achieved in one case. The other two cases showed partial regression of signs. Levels of 17 OH progesterone reached normal parameters in all cases. Steroids doses were lowered and given only for replacement purposes. Mean operative time was 125, 65 and 60min for whole, right and left procedure, respectively. Median blood loss remained under 50ml in all cases and there were no complications. Median postoperative pain level was 5 according to visual analog pain scale. Median hospital stay was 4 days. CONCLUSION Bilateral simultaneous laparoscopic adrenalectomy shows all the advantages of minimally invasive surgery, and appears a viable alternative to medical management, which is not exempt from complications.
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Mclean K, Lilienfeld H, Caracciolo JT, Hoffe S, Tourtelot JB, Carter WB. Management of Isolated Adrenal Lesions in Cancer Patients. Cancer Control 2011; 18:113-26. [DOI: 10.1177/107327481101800206] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Kelly Mclean
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Howard Lilienfeld
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Sarah Hoffe
- Radiation Oncology Program at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - John B. Tourtelot
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - W. Bradford Carter
- Endocrine Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Valeri A, Bergamini C, Tozzi F, Martellucci J, Di Costanzo F, Antonuzzo L. A multi-center study on the surgical management of metastatic disease to adrenal glands. J Surg Oncol 2010; 103:400-5. [PMID: 21400523 DOI: 10.1002/jso.21843] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 11/29/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND In the management of adrenal lesions in oncological patients, many issues are still controversial: morphological signs of suspected malignancy, accuracy of imaging examinations, use of fine needle aspiration (FNA), and the role of laparoscopy. The present study attempts to address these questions through the evaluation of the management of adrenal metastases (AM) in a wide cohort of patients included in the Italian Register of Endoscopic Adrenal Surgery. METHODS In January 2009, all patients recorded on the Register were evaluated, on the basis of CT scan, MRI, and FNA. The diagnostic, surgical, and follow-up data of 95 patients with pre-operative AM diagnosis have been reviewed. On the basis of the fulfilled criteria three patterns were identified: "diagnostic", "suspect," and "non-diagnostic." RESULTS CT scan sensitivity was 41.5%/77.9% and specificity was 54.5%/90.9% for "diagnostic"/"diagnostic" + "suspect" examinations, respectively. MRI sensitivity was 15.7%/78.9% and specificity was non-determinate/83.3% for "diagnostic"/"diagnostic" + "suspect" exams, respectively. Sensitivity of FNA was 33.3%. About surgery, conversions rate was 16.6%; no mortality or re-operations were reported; complications rate was 10.7%; and no relation was noted between tumor size and surgical outcome. Mean survival was 32 months; 5-year survival was 23%, independent of AM size; survival for lung AM was similar to that of breast and kidney AM. CONCLUSIONS Laparoscopy for AM, in expert hand, seems to be a feasible and oncologically safe approach. Due to the unsatisfactory diagnostic accuracy for AM, every oncological patient with suspect adrenal lesions should be encouraged to undergo this surgical procedure.
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Affiliation(s)
- Andrea Valeri
- Azienda Ospedaliero-Universitaria Careggi SOD 1 Chirurgia Generale, D'Urgenza e Mini-Invasiva, Florence, Italy
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Hevia Suárez M, Abascal Junquera J, Boix P, Dieguez M, Delgado E, Abascal García J, Abascal García R. [Surgical experience and results in transperitoneal laparoscopic adrenalectomy]. Actas Urol Esp 2010. [PMID: 20470713 DOI: 10.1016/j.acuro.2010.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Laparoscopic adrenalectomy is currently the gold standard in surgical management of adrenal pathology. OBJECTIVES To analyze our results after 12 years of experience in this surgery and to compare with the main published series. MATERIAL AND METHODS we describe retrospectively 100 adrenalectomies performed between 1997-2009. Analyzed variables: age, size, side, preoperative diagnosis, operative time, blood loss, reconversion, hospital stay and histopathologic report. We utilized Fisher test and chi square test to compare categoric data. We utilized t-Student test to compare means from independent groups with normal distribution. We considered statistical significance when p<0.05. RESULTS Mean age was 53.1 years (+/-14.4). Mean size was 3,7 cm (+/-2.2). In 51% of cases it was the left side. Mean follow-up was 15 months (+/-11.9). Preoperative diagnosis was: functional mass (44%), pheocromocytome (17%), incedentaloma>4 cm (20%), metastasis (10%) and adrenal carcinoma (5%). Mean operative time was 145.1 min (+/-55.6). Mean hematocrite loss was 6.26 points (+/-3.3). Reconversion rate was 9.6%. 2 cases of prolonged postoperative ileus. 2 patients required transfusion. 1 patient death because of an descompensation of liver cirrhosis. 80% of complications were on right side. Mean hospital stay was 6 days (+/-5.6). In last 30 procedures we realized statistical differences with first group, in terms of operative time (119.1 min vs 171.2 min) and hospital stay (4.1 days vs 6.1) (p<0.05). CONCLUSIONS Transperitoneal laparoscopic adrenalectomy is a surgical feasible and safe procedure in urological groups with previous laparoscopic experience. Our results are similar with the published series and confirm the efficacy, security and reproducibility of this technique.
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Outcomes after laparoscopic adrenalectomy. Surg Endosc 2010; 25:784-94. [DOI: 10.1007/s00464-010-1256-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Accepted: 07/10/2010] [Indexed: 01/08/2023]
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The sub-peritoneal arterial plexus of Sir William Turner. Ann Anat 2010; 192:194-8. [PMID: 20634049 DOI: 10.1016/j.aanat.2010.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 04/25/2010] [Accepted: 05/15/2010] [Indexed: 11/21/2022]
Abstract
Sir William Turner (1832-1916) was Professor of Anatomy at the University of Edinburgh. His classic paper of 1863 on the anastomoses between the parietal and visceral branches of the abdominal aorta, later known as the sub-peritoneal arterial plexus of Turner, has mostly been forgotten. Located in the retroperitoneum and surrounding the kidneys and other adjacent structures, this plexus is an important route of collateral circulation. In the current paper, we discuss the sub-peritoneal arterial plexus as described by Turner in 1863 and review the literature concerning its potential clinical significance in the kidney, emphasizing its probable role in the metastatic spread of various tumors of abdominal organs and in the continuing viability of the kidney after renal artery occlusion. A biographical sketch of Sir William Turner is also presented.
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Muth A, Persson F, Jansson S, Johanson V, Ahlman H, Wängberg B. Prognostic factors for survival after surgery for adrenal metastasis. Eur J Surg Oncol 2010; 36:699-704. [PMID: 20452170 DOI: 10.1016/j.ejso.2010.04.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 02/04/2010] [Accepted: 04/05/2010] [Indexed: 12/22/2022] Open
Abstract
AIM To better define the indications for adrenalectomy for adrenal metastasis we have analysed factors predicting survival in our institutional series. METHODS A consecutive series of 30 patients undergoing adrenalectomy for metastasis (1996-2007), excluding patients with simultaneous ipsilateral renal cell carcinoma (RCC), was studied. Metastases were regarded as synchronous (<6 mo), or metachronous (>6 mo), depending on the interval after primary surgery. Survival was calculated from time of adrenalectomy and factors influencing survival were identified. RESULTS The tumour diagnoses were RCC n = 9, malignant melanoma n = 5, non-small-cell lung cancer n = 5, colorectal carcinoma n = 4, foregut carcinoid n = 2, adrenocortical carcinoma, breast cancer, hepatocellular carcinoma, urothelial carcinoma, and liposarcoma (one each); nine adrenal metastases were synchronous and 21 metachronous. Ten patients had undergone previous surgery for extra-adrenal metastases. Out of 30 adrenalectomies 10 were laparoscopic (LAdx) and 20 open (OAdx) procedures without surgical complications. The local recurrence rate was low: LAdx 1/10, OAdx 1/20, and the median survival was 23 months. Independent prognosticators of favourable survival were adrenalectomy for potential cure (p = 0.01), no previous metastasis surgery (p = 0.02), and tumour type (p = 0.043), with better prognosis for patients with adrenal metastasis from colorectal carcinoma and RCC and worse prognosis in non-small-cell lung cancer and malignant melanoma. CONCLUSIONS Surgery for adrenal metastasis is safe and the indication for this procedure in an individual patient can be supported by several prognostic factors. The survival benefit in patients with adrenalectomy for potential cure indicates a therapeutic value of adrenalectomy in selected patients.
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Affiliation(s)
- A Muth
- Endocrine Surgery Unit, Institute of Clinical Sciences, Sahlgrenska Academy, SE-413 45 Gothenburg, Sweden.
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Pascual Piédrola JI, Rincón Mayans A, Tolosa Eizaguirre E, Barba Abad J, Romero Vargas L, Rosell Costa D. [Laparoscopic adrenalectomy for metachronous metastasis. Experience in 12 cases]. Actas Urol Esp 2010; 34:201-5. [PMID: 20403287 DOI: 10.1016/s2173-5786(10)70041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the peroperative and oncological results of laparoscopic adrenalectomy for an isolated metastasis. MATERIAL AND METHODS A retrospective, descriptive study was conducted of 12 laparoscopic adrenalectomies performed for metastases out of a total of 40 adrenalectomies performed from May 1998 to April 2009. The primary tumor was pulmonary in 7 patients, renal in 3, and colonic in 2. Demographic data collected included median age, operating time, blood loss, complications, tumor size, and length of hospital stay. The Kaplan-Meier method was used to analyze survival. RESULTS Operating time was 150 min (range, 90-206). Peroperative bleeding was 60 ml (range, 15-150). Peroperative complications occurred in 3% of patients. Tumor size was 4.5 cm (range, 1.3-8.5). No positive margins were seen in the resected specimens. Hospital stay was 3 days (range 3-5). Actuarial survival was 55.6% at 23 months (range, 2-38) with mean and median follow-up times of 20.9 and 23 months. CONCLUSIONS In selected patients, laparoscopic adrenalectomy for metastasis is a safe procedure with oncological results superimposable to those of open surgery.
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Affiliation(s)
- J I Pascual Piédrola
- Departamento de Urología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
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Pockaj BA, Wasif N, Dueck AC, Wigle DA, Boughey JC, Degnim AC, Gray RJ, McLaughlin SA, Northfelt DW, Sticca RP, Jakub JW, Perez EA. Metastasectomy and surgical resection of the primary tumor in patients with stage IV breast cancer: time for a second look? Ann Surg Oncol 2010; 17:2419-26. [PMID: 20232163 DOI: 10.1245/s10434-010-1016-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Indexed: 12/17/2022]
Abstract
Patients with metastatic or stage IV breast cancer have limited therapeutic options, and the mainstay of treatment remains systemic chemotherapy. Traditionally, the role of surgery has been confined to strict palliation. Improvements in the efficacy of chemotherapeutic regimens, coupled with the use of hormonal and targeted therapy, have resulted in an expansion of surgical resection beyond simple palliation. Several single-institution studies have reported improved survival and even long-term cures after surgical resection for oligometastatic stage IV breast cancer. Similarly, provocative new data suggest that removal of the primary tumor in some patients may confer a survival advantage. The aim of this review is to summarize studies in the medical literature pertaining to the use of surgical resection in patients with stage IV breast cancer. We believe there is enough evidence to challenge conventional thinking about the role of surgery in stage IV breast cancer and to consider a new multimodality treatment paradigm to optimize patient outcomes. It is time to conduct a carefully designed randomized trial to see whether surgery in stage IV breast cancer does indeed warrant a second look.
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Kazaryan AM, Marangos IP, Rosseland AR, Røsok BI, Villanger O, Pinjo E, Pfeffer PF, Edwin B. Laparoscopic adrenalectomy: Norwegian single-center experience of 242 procedures. J Laparoendosc Adv Surg Tech A 2009; 19:181-9. [PMID: 19216698 DOI: 10.1089/lap.2008.0286] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The last 15 years have been characterized by a rapid expansion of minimally invasive surgery as treatment for adrenal diseases. During these years, both indications and surgical techniques have shown improvements. This study analyzed an 11-year single-center experience with laparoscopic adrenalectomy. MATERIALS AND METHODS Between January 1997 and April 2008, 242 laparoscopic adrenalectomies were performed in 220 patients at Rikshospitalet University Hospital. Of these, 192 patients were operated on for benign lesions, 23 for malignant lesions, and in 5 cases "en bloc" adrenalectomies were performed. Benign lesions included 136 hormonally active lesions (41 pheochromocytomas, 48 Conn adenomas, 25 Cushing adenomas, and 18 patients with Cushing's disease) and 56 with hormonally inactive lesions (among them, 47 nonfunctional adenomas). Malignant lesions included 16 adrenal metastases and 7 adrenocortical carcinomas. RESULTS All adrenalectomies were completed laparoscopically. The median time of unilatateral adrenalectomy was 85 (range, 35-325) minutes. The median blood loss was 0 (range, 0-1100) mL. There were 6 intraoperative and 7 postoperative minor complications. The number of complications did not differ between the types of adrenal pathology. Only 19% of the patients required opioids postoperatively. Per- and postoperative parameters were homogeneous among patients with different adrenal lesions. The patients with adrenocortical carcinoma had a distinctive intraoperative course with an evidently longer operative time and higher blood loss. The median postoperative hospital stay was 2 (range, 1-15) days. Hospital stay was the only postoperative parameter where a difference was found between patients with different adrenal lesions. The patients with carcinoma, pheochromocytoma, and Cushing's disease had the longest median postoperative stay, respectively, 5 (range, 2-6), 3 (range, 1-15), and 3 (range, 2-6) days. CONCLUSIONS Laparoscopic adrenalectomy is a safe, effective procedure providing improved fast and uncomplicated patient recovery independent of the type of adrenal lesion. Laparoscopic adrenalectomy can be easily introduced and may soon replace traditional open surgery in specialized centers.
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Marangos IP, Kazaryan AM, Rosseland AR, Røsok BI, Carlsen HS, Kromann-Andersen B, Brennhovd B, Hauss HJ, Giercksky KE, Mathisen Ø, Edwin B. Should we use laparoscopic adrenalectomy for metastases? Scandinavian multicenter study. J Surg Oncol 2009; 100:43-7. [PMID: 19431158 DOI: 10.1002/jso.21293] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Laparoscopic adrenalectomy for metastases is considered controversial. Multicenter retrospective study was performed to gain new knowledge in this issue. MATERIALS AND METHODS From January 1997 till November 2008, 41 adrenalectomies were performed during follow-up of the patients operated for malignant tumors. The median age was 64 (52-77) years. Metastases were confirmed in 31/41 cases. Metastatic lesions were further studied and to define factors influencing on survival, patients were divided to sub-groups of metachronous/synchronous, tumor origin and tumor size. RESULTS The median operative time was 104 (50-230) min, the median blood loss was 100 (0-500) ml. One procedure (3.2%) was converted. There were 3 (10.7%) intraoperative and 2 (7.4%) postoperative complications. The median tumor size was 6 (1.5-16) cm. Pathohistological analysis revealed 12 colorectal, 9 renal cell carcinoma, 5 lung carcinoma, 4 melanoma, and 1 hepatocellular metastases. The resection margin was not free in one case (3.7%). The median hospital stay was 2 (1-21) days. The median length of survival was 29 +/- 2.1 months for all patients. CONCLUSION Laparoscopic adrenalectomy for metastases is feasible regardless of their sizes. However these procedures should be performed by highly skilled laparoscopic surgeon in a fully equipped operating room and with a coordinated operation team.
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Surgical management of metastases to the adrenal gland: open, laparoscopic, and ablative approaches. Curr Urol Rep 2009; 10:67-72. [PMID: 19116098 DOI: 10.1007/s11934-009-0012-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The adrenal gland is a potential site of metastasis for various malignancies. Metastases to the adrenal gland are the second most common type of adrenal mass lesion after adenomas. Differentiation of a metastatic lesion from a primary adrenal lesion can be challenging and requires the selective use of radiologic imaging, serologic testing, and adrenal biopsy. In patients who present with an isolated adrenal metastasis, adrenalectomy is often considered to aid in cancer control. Numerous studies have reported improved survival with resection of solitary adrenal metastases for various types of primary tumors. Traditionally, open adrenalectomy was the preferred option for these patients. More recently, laparoscopic adrenalectomy has offered a minimally invasive approach, with its resultant advantages of improved perioperative parameters. Proper patient selection for the laparoscopic versus open approach remains paramount in deciding the best treatment for the individual patient.
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Kumar A, Hyams ES, Stifelman MD. Robot-Assisted Partial Adrenalectomy for Isolated Adrenal Metastasis. J Endourol 2009; 23:651-4. [DOI: 10.1089/end.2008.0440] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
BACKGROUND Metachronous adrenal metastases (AM) from renal cell carcinoma (RCC) are rare. We report our experience of surgical resection in this setting, with particular respect to laparoscopic approach and long-term outcome. METHODS A retrospective review of 11 patients who underwent adrenalectomy for metachronous AM from RCC was conducted between 2002 and 2005 in a tertiary referral center. RESULTS CT scan findings were those of an adrenal mass ranging from 2 to 13 cm in diameter with a basal density of 12 to 28 Hounsfield Units and strong heterogeneous enhancement following contrast injection. The surgical procedure consisted of controlateral (n = 5), ipsilateral (n = 2), and bilateral (n = 1) laparoscopic adrenalectomy, whereas three patients underwent controlateral open adrenalectomy for adrenal mass >10 cm. Nine patients were recurrence-free with a median follow-up of 34 months. In the remaining two patients, lung metastases were discovered at postoperative months 28 and 11, respectively. The former patient is alive and free of disease recurrence 32 months after lung metastasis resection, whereas the latter is currently being treated with sunitinib. CONCLUSIONS This study confirms that prolonged overall and disease free-survival can be achieved in selected patient after laparosocpic adrenalectomy for AM from RCC.
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40
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Pohl PP, Meyer A, Lammers BJ, Goretzki PE. [Abdominal preoperation. No contraindication for laparoscopic transabdominal adrenalectomy]. Chirurg 2008; 79:571-5. [PMID: 17879074 DOI: 10.1007/s00104-007-1400-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Benign adrenal gland tumors smaller than 6 cm are nowadays the indication for minimally invasive surgery. Until now there has been no significant difference between retroperitoneoscopic and transabdominal adrenalectomy. Intestinal adhesions could be a contraindication against transabdominal laparoscopic adrenalectomy, and therefore the retroperitoneoscopic approach could be an advantage in these cases. A prospective study concerning this question has not been published yet. Our clinical investigation here includes 114 adrenalectomies during the last 5 years. We show that in any case of abdominal preoperation, laparoscopic adrenalectomy can be performed by transabdominal approach and without conversion to open surgery. Discussed are the different indications for laparoscopic adrenalectomy, operating time, conversion rate to open surgery, and amount and type of abdominal preoperation. We compared patients with and without abdominal preoperations.
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Affiliation(s)
- P P Pohl
- Klinik für Allgemein-, Visceral-, Gefäss- und Thoraxchirurgie, Städtische Kliniken Neuss,Lukaskrankenhaus-GmbH, Preussenstrasse 84, 41464, Neuss, Deutschland.
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41
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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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Strebel RT, Müntener M, Sulser T. Intraoperative complications of laparoscopic adrenalectomy. World J Urol 2008; 26:555-60. [PMID: 18481069 DOI: 10.1007/s00345-008-0272-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 04/19/2008] [Indexed: 12/12/2022] Open
Abstract
A laparoscopic or retroperitoneoscopic access to the adrenal gland is the standard of care for adrenalectomy in most cases. Although in laparoscopic adrenalectomy the approach is minimally invasive, the procedure is challenging. This is reflected in the scope of possible complications. The surgeon must consider complications related to the anatomical topography of the adrenal gland, which typically encompasses the complications known from open surgery and complications related to the minimal invasive access. In this topic paper we will address the most frequently encountered complications of adrenalectomy: vascular injuries, injuries of the bowel, pleural tears, and injuries to the liver, spleen and pancreas. Fortunately, these complications occur rarely. However, many of these complications can have devastating consequences. Therefore, it's the surgeon's obligation to be aware of the possible complications he might encounter during laparoscopic adrenalectomy. This awareness is essential for their prevention and it helps the laparoscopic surgeon to identify complications intraoperatively.
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Affiliation(s)
- Raeto T Strebel
- Department of Urology, Kantonsspital Graubünden, Loëstr. 170, 7000, Chur, Switzerland.
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Katoh N, Onimaru R, Sakuhara Y, Abo D, Shimizu S, Taguchi H, Watanabe Y, Shinohara N, Ishikawa M, Shirato H. Real-time tumor-tracking radiotherapy for adrenal tumors. Radiother Oncol 2008; 87:418-24. [PMID: 18439693 DOI: 10.1016/j.radonc.2008.03.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 03/17/2008] [Accepted: 03/21/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the three-dimensional movement of internal fiducial markers near the adrenal tumors using a real-time tumor-tracking radiotherapy (RTRT) system and to examine the feasibility of high-dose hypofractionated radiotherapy for the adrenal tumors. MATERIALS AND METHODS The subjects considered in this study were 10 markers of the 9 patients treated with RTRT. A total of 72 days in the prone position and 61 treatment days in the supine position for nine of the 10 markers were analyzed. All but one patient were prescribed 48 Gy in eight fractions at the isocenter. RESULTS The average absolute amplitude of the marker movement in the prone position was 6.1+/-4.4 mm (range 2.3-14.4), 11.1+/-7.1 mm (3.5-25.2), and 7.0+/-3.5 mm (3.9-12.5) in the left-right (LR), craniocaudal (CC), and anterior-posterior (AP) directions, respectively. The average absolute amplitude in the supine position was 3.4+/-2.9 mm (0.6-9.1), 9.9+/-9.8 mm (1.1-27.1), and 5.4+/-5.2 mm (1.7-26.6) in the LR, CC, and AP directions, respectively. Of the eight markers, which were examined in both the prone and supine positions, there was no significant difference in the average absolute amplitude between the two positions. No symptomatic adverse effects were observed within the median follow-up period of 16 months (range 5-21 months). The actuarial freedom-from-local-progression rate was 100% at 12 months. CONCLUSIONS Three-dimensional motion of a fiducial marker near the adrenal tumors was detected. Hypofractionated RTRT for adrenal tumors was feasible for patients with metastatic tumors.
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Affiliation(s)
- Norio Katoh
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Collinson FJ, Lam TK, Bruijn WMJ, de Wilt JHW, Lamont M, Thompson JF, Kefford RF. Long-term Survival and Occasional Regression of Distant Melanoma Metastases after Adrenal Metastasectomy. Ann Surg Oncol 2008; 15:1741-9. [DOI: 10.1245/s10434-008-9836-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 01/14/2008] [Accepted: 01/15/2008] [Indexed: 01/10/2023]
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Eto M, Hamaguchi M, Harano M, Yokomizo A, Tatsugami K, Naito S. Laparoscopic adrenalectomy for malignant tumors. Int J Urol 2008; 15:295-8. [DOI: 10.1111/j.1442-2042.2008.01997.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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