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Zhang K, Zhang Y, Zhang Y, Chao M. A retrospective analysis of the clinical characteristics of 207 hospitalized children with adrenal masses. Front Pediatr 2023; 11:1215095. [PMID: 37520057 PMCID: PMC10374947 DOI: 10.3389/fped.2023.1215095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Objective The detection rates of adrenal masses (AMs) have recently increased. The present study aimed to examine the clinical characteristics of these adrenal masses for guiding the clinical diagnosis and treatment among hospitalized children. Methods The clinical data of AM cases admitted to our hospital from January 2014 to March 2023 were collected and analyzed retrospectively. The data included composition, sex, age, initial presentation, size and site of mass, functional tumor, intervention or surgery, pathological or clinical diagnosis, and imaging data. Results A total of 207 hospitalized children were included. Among them, adrenal hematoma was the most common finding (53.6%), followed by adrenal neuroblastoma (36.2%). Most masses were larger-sized (51.2%) and non-functional (94.7%). We found that adrenal hematoma commonly occurred in a neonate or child with abdominal trauma. Most adrenal hematoma cases were found in male patients (63.1%), on the right side (71.2%), and with sizes <4 cm (73.9%). Adrenal neuroblastoma was commonly detected in male patients (56.0%), on the right side (66.7%), and with sizes ≥4 cm (85.3%). Moreover, the metastases were frequently explored at the time of diagnosis. In addition, there was no significant difference between ultrasound and computed tomography (CT) scans under suspicion of hematoma (P > 0.05). However, CT showed a priority over ultrasound in the diagnosis of neuroblastoma (P < 0.05). Conclusion Most masses were non-functional and benign. Of these, adrenal hematoma was the most common type of pediatric AM, followed by adrenal neuroblastoma. They were both commonly found in male patients and on the right side. Neuroblastoma revealed a larger tumor size. Compared to cases of adrenal hematoma, cases of adrenal neuroblastoma required CT scans for further assessment.
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Affiliation(s)
| | | | | | - Min Chao
- Correspondence: Yin Zhang Min Chao
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Moreno P, de la Quintana Basarrate A, Musholt TJ, Paunovic I, Puccini M, Vidal Ó, Ortega J, Kraimps JL. Laparoscopy versus open adrenalectomy in patients with solid tumor metastases: results of a multicenter European study. Gland Surg 2020; 9:S159-S165. [PMID: 32175257 DOI: 10.21037/gs.2019.10.15] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The outcome of adrenalectomy carried out by laparoscopy or open surgery for solid tumor metastases was assessed. Methods A total of 317 patients with histologically confirmed adrenal metastatic disease collected from 30 centres in Europe underwent adrenalectomy by laparoscopy (n=146) or open laparotomy (n=171). Differences between laparoscopic and open adrenalectomy were assessed by a single Cox analysis for both procedures. Results The median overall survival was 24.0 [95% confidence interval (CI): 21.4-26.6] months for open adrenalectomy and 45.0 (95% CI: 22.6-67.4) for laparoscopic adrenalectomy (P=0.008). Survival rates were 68%, 49%, 35% and 29% at 1, 2, 3 and 5 years for open surgery vs. 88%, 62%, 52% and 46% for laparoscopy, respectively. In the subgroup of R0 resections, the difference in survival in favor of laparoscopy (median 46 vs. 27 months) was marginally significant (P=0.073). Renal cancer [hazard ratio (HR) 0.42; 95% CI: 0.23-0.76, P=0.005], surgery of the primary tumor (HR 0.33; 95% CI: 0.19-0.54), and use of chemotherapy (HR 0.62; 95% CI: 0.43-0.88) were associated with a better survival, whereas type of resection (R1/R2 vs. R0) was associated with a worse prognosis (HR 2.29; 95% CI: 1.52-3.44, P<0.001). Conclusions Laparoscopic adrenalectomy patients showed a longer survival than open adrenalectomy individuals, as minimally invasive approach was attempted more common in less advanced disease which led to higher number of R0 resections.
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Affiliation(s)
- Pablo Moreno
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Thomas J Musholt
- Endocrine Surgery Section, Department of General, Visceral-, and Transplantation, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinical Centre of Serbia Medical School, University of Belgrade, Belgrade, Serbia
| | - Marco Puccini
- Department of General Surgery, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Óscar Vidal
- Department of General & Endocrine Surgery, ICMDiM, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Joaquín Ortega
- Department of Surgery, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | - Jean-Louis Kraimps
- Department of Endocrine Surgery, Jean Bernard Hospital, Poitiers University, Poitiers, France
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Moreno P, de la Quintana Basarrate A, Musholt TJ, Paunovic I, Puccini M, Vidal Ó, Ortega J, Kraimps JL. Laparoscopy versus open adrenalectomy in patients with solid tumor metastases: results of a multicenter European study. Gland Surg 2020. [PMID: 32175257 DOI: 10.21037/gs.22019.21010.21015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND The outcome of adrenalectomy carried out by laparoscopy or open surgery for solid tumor metastases was assessed. METHODS A total of 317 patients with histologically confirmed adrenal metastatic disease collected from 30 centres in Europe underwent adrenalectomy by laparoscopy (n=146) or open laparotomy (n=171). Differences between laparoscopic and open adrenalectomy were assessed by a single Cox analysis for both procedures. RESULTS The median overall survival was 24.0 [95% confidence interval (CI): 21.4-26.6] months for open adrenalectomy and 45.0 (95% CI: 22.6-67.4) for laparoscopic adrenalectomy (P=0.008). Survival rates were 68%, 49%, 35% and 29% at 1, 2, 3 and 5 years for open surgery vs. 88%, 62%, 52% and 46% for laparoscopy, respectively. In the subgroup of R0 resections, the difference in survival in favor of laparoscopy (median 46 vs. 27 months) was marginally significant (P=0.073). Renal cancer [hazard ratio (HR) 0.42; 95% CI: 0.23-0.76, P=0.005], surgery of the primary tumor (HR 0.33; 95% CI: 0.19-0.54), and use of chemotherapy (HR 0.62; 95% CI: 0.43-0.88) were associated with a better survival, whereas type of resection (R1/R2 vs. R0) was associated with a worse prognosis (HR 2.29; 95% CI: 1.52-3.44, P<0.001). CONCLUSIONS Laparoscopic adrenalectomy patients showed a longer survival than open adrenalectomy individuals, as minimally invasive approach was attempted more common in less advanced disease which led to higher number of R0 resections.
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Affiliation(s)
- Pablo Moreno
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Thomas J Musholt
- Endocrine Surgery Section, Department of General, Visceral-, and Transplantation, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ivan Paunovic
- Center for Endocrine Surgery, Clinical Centre of Serbia Medical School, University of Belgrade, Belgrade, Serbia
| | - Marco Puccini
- Department of General Surgery, Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Óscar Vidal
- Department of General & Endocrine Surgery, ICMDiM, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Joaquín Ortega
- Department of Surgery, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | - Jean-Louis Kraimps
- Department of Endocrine Surgery, Jean Bernard Hospital, Poitiers University, Poitiers, France
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de Gordejuela AGR, Gebelli JP, García NV, Medayo LS, Marín AE, Badía AC. One stage laparoscopic left adrenalectomy and sleeve gastrectomy by direct supragastric approach. Int J Surg Case Rep 2014; 5:22-5. [PMID: 24394858 PMCID: PMC3907198 DOI: 10.1016/j.ijscr.2013.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 10/04/2013] [Accepted: 11/14/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The advances in laparoscopic surgical technique and the greater experience of surgical teams have enabled the combination of different surgical techniques in a single procedure. This paper presents a case of a sleeve gastrectomy and a left adrenalectomy by laparoscopy for a morbidly obese patient with Cushing's syndrome. PRESENTATION OF CASE A 52 year-old male patient with a BMI of 53kg/m(2) was diagnosed as having Cushing's syndrome caused by a left adrenal tumor. Sleeve gastrectomy was performed according to the usual technique. The adrenalectomy was performed at the same time by a left supragastric approach. The evolution was favorable, with 52% of excess weight loss observed after six months. Plasma and urinary cortisol at the 3- and 6-month follow-ups were under normal range and the patient required glucocorticoid therapy, confirming the cure of Cushing's syndrome. DISCUSSION Teams with experience of advanced laparoscopic surgery can successfully combine complex procedures in one surgical period. The approach we used for the adrenalectomy proved itself to be feasible after the sleeve gastrectomy. CONCLUSION Both procedures can be safely done in experience teams. Sleeve gastrectomy facilitates the direct supragastric approach.
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Affiliation(s)
- Amador G Ruiz de Gordejuela
- Servei de Cirurgia General i de l'Aparell Digestiu, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Jordi Pujol Gebelli
- Servei de Cirurgia General i de l'Aparell Digestiu, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Vilarrasa García
- Servei d'Endocrinologia i Nutrició, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lluis Secanella Medayo
- Servei de Cirurgia General i de l'Aparell Digestiu, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Araceli Estepa Marín
- Servei d'Endocrinología i Nutrició, Hospital Sant Camil, c/Carç, n°0, 08810 Sant Pere de Ribes, Barcelona, Spain
| | - Anna Casajoana Badía
- Servei de Cirurgia General i de l'Aparell Digestiu, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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Kishi K, Tamura S, Mabuchi Y, Sonomura T, Noda Y, Nakai M, Sato M, Ino K, Yamanaka N. Percutaneous interstitial brachytherapy for adrenal metastasis: technical report. JOURNAL OF RADIATION RESEARCH 2012; 53:807-14. [PMID: 22843376 PMCID: PMC3430424 DOI: 10.1093/jrr/rrs047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 05/06/2012] [Accepted: 06/06/2012] [Indexed: 06/01/2023]
Abstract
We developed and evaluated the feasibility of a brachytherapy technique as a safe and effective treatment for adrenal metastasis. Adapting a paravertebral insertion technique in radiofrequency ablation of adrenal tumors, we developed an interstitial brachytherapy for adrenal metastasis achievable on an outpatient basis. Under local anesthesia and under X-ray CT guidance, brachytherapy applicator needles were percutaneously inserted into the target. A treatment plan was created to eradicate the tumor while preserving normal organs including the spinal cord and kidney. We applied this interstitial brachytherapy technique to two patients: one who developed adrenal metastasis as the third recurrence of uterine cervical cancer after reirradiation, and one who developed metachronous multiple metastases from malignant melanoma. The whole procedure was completed in 2.5 hours. There were no procedure-related or radiation-related early/late complications. FDG PET-CT images at two and three months after treatment showed absence of FDG uptake, and no recurrence of the adrenal tumor was observed for over seven months until expiration, and for six months until the present, respectively. This interventional interstitial brachytherapy procedure may be useful as a safe and eradicative treatment for adrenal metastasis.
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Affiliation(s)
- Kazushi Kishi
- Department of Radiation Oncology, Wakayama Medical University, Wakayama City, 641-8510 Japan.
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Allemann P, Perretta S, Asakuma M, Dallemagne B, Marescaux J. NOTES new frontier: Natural orifice approach to retroperitoneal disease. World J Gastrointest Surg 2010; 2:157-64. [PMID: 21160866 PMCID: PMC2999234 DOI: 10.4240/wjgs.v2.i5.157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 02/06/2010] [Accepted: 02/13/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To develop a pure transvaginal access to the retroperitoneum, that is simple, reproducible and uses endoscopic material available on the market.
METHODS: From February 2008 to April 2009, 31 pigs were operated on, with 17 as an acute experiment and 14 with a survival protocol. The animals were placed in a supine position and a 12-mm double-channel endoscope (Karl Storz™, Tuttlingen) was used for vision and dissection. During the same time period, the access experiment was reproduced on 3 human cadavers using material similar to that used in the animal model.
RESULTS: In the animal model, 37 interventions were done on the kidney, adrenal gland and pancreas. The mean time to fashion the access was 10 min (range 5 to 20 min). No intraoperative death was observed. Two major (5%) intraoperative complications occurred: one hemorrhage on the aorta and one tearing of the right renal vein. Peritoneal laceration was encountered in 5 cases without impairing the planned task. In the survival group, good clinical outcome was observed at a mean follow-up of 3 wk (range 2 to 6 wk). In the 3 cadavers, access was performed correctly. The mean time to fashion the access was 52 min (range 40 to 60 min). All the anatomical landmarks described in the pig model were clearly identified in the same sequence.
CONCLUSION: A retroperitoneal natural orifice translumenal surgical transvaginal approach is feasible in both animal and human models and allows performance of a large panel of interventions.
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Affiliation(s)
- Pierre Allemann
- Pierre Allemann, Silvana Perretta, Mitsuhiro Asakuma, Bernard Dallemagne, Jacques Marescaux, IRCAD/EITS Institute, Strasbourg University Hospital, 1, place de l'hôpital, 67000 Strasbourg, France
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FRANSSON BOELA, KEEGAN ROBERTD, RAGLE CLAUDEA, HALDORSON GARYJ, GREENE STEPHENA. Hemodynamic Changes During Laparoscopic Radiofrequency Ablation of Normal Adrenal Tissue in Dogs. Vet Surg 2009; 38:490-7. [DOI: 10.1111/j.1532-950x.2009.00533.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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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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Porterfield JR, Thompson GB, Young WF, Chow JT, Fryrear RS, van Heerden JA, Farley DR, Atkinson JLD, Meyer FB, Abboud CF, Nippoldt TB, Natt N, Erickson D, Vella A, Carpenter PC, Richards M, Carney JA, Larson D, Schleck C, Churchward M, Grant CS. Surgery for Cushing's syndrome: an historical review and recent ten-year experience. World J Surg 2008; 32:659-77. [PMID: 18196319 DOI: 10.1007/s00268-007-9387-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cushing's syndrome (CS), due to multiple etiologies, is a disorder associated with the ravages of cortisol excess. The purpose of this review article is to provide a historical synopsis of surgery for CS, review a recent 10-year period of operative management at a tertiary care facility, and to outline a practical approach to diagnosis and management. MATERIALS AND METHODS From 1996 to 2005, 298 patients underwent 322 operative procedures for CS at Mayo Clinic, Rochester, Minnesota. A retrospective chart review was carried out. Data was gathered regarding demographics, preoperative assessment, procedures performed, and outcomes. Data are presented as counts and percentages. Five-year survival rates were calculated where applicable by the Kaplan-Meier method. Statistical analysis was carried out with SAS, version 9 (SAS Institute, Inc., Cary, NC). RESULTS Two-hundred thirty-one patients (78%) had ACTH-dependent CS and 67 patients (22%) had ACTH-independent CS. One-hundred ninety-six patients (66%) had pituitary-dependent CS and 35 patients (12%) had ectopic ACTH syndrome. Fifty-four patients (18%) had cortisol-secreting adenomas, 10 patients (3%) had cortisol-producing adrenocortical carcinomas, and 1% had other causes. Cure rates for first time pituitary operations (transsphenoidal, sublabial, and endonasal) were 80% and 55% for reoperations. Most benign adrenal processes could be managed laparoscopically. Five-year survival rates (all causes) were 90%, 51%, and 23% for adrenocortical adenomas, ectopic ACTH syndrome, and adrenocortical carcinomas, respectively. CONCLUSIONS Surgery for CS is highly successful for pituitary-dependent CS and most ACTH-independent adrenal causes. Bilateral total adrenalectomy can also provide effective palliation from the ravages of hypercortisolism in patients with ectopic ACTH syndrome and for those who have failed transsphenoidal surgery. Unfortunately, to date, adrenocortical carcinomas are rarely cured. Future successes with this disease will likely depend on a better understanding of tumor biology, more effective adjuvant therapies and earlier detection. Clearly, IPSS, advances in cross-sectional imaging, along with developments in transsphenoidal and laparoscopic surgery, have had the greatest impact on today's management of the complex patient with CS.
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Affiliation(s)
- John R Porterfield
- Department of Surgery, Mayo Clinic and Mayo Foundation, 200 First Street, S.W, Rochester, MN 55905, USA
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Kapella M, Genet D, Pech de Laclause B, Durand-Fontanier S, Lachachi M, Fabre A, Valleix D, Descottes B. Métastase surranélienne : survie après chirurgie d’exérèse. ACTA ACUST UNITED AC 2008; 145:346-9. [DOI: 10.1016/s0021-7697(08)74314-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Disick GIS, Munver R. Adrenal-preserving minimally invasive surgery: update on the current status of laparoscopic partial adrenalectomy. Curr Urol Rep 2008; 9:67-72. [PMID: 18366977 DOI: 10.1007/s11934-008-0013-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adrenalectomy is the standard of care for hormonally active adrenal masses. In recent years, minimally invasive laparoscopic excision has become a preferred management option. As with advances in parenchymal-sparing renal surgery, investigators have begun to examine adrenal-sparing procedures to preserve functional adrenal tissue. This article reviews the recent literature and reports on intermediate results with laparoscopic partial adrenalectomy (LPA).
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Affiliation(s)
- Grant I S Disick
- Department of Urology, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1272, New York, NY 10029, USA.
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Shiozawa M, Sata N, Endo K, Koizumi M, Yasuda Y, Nagai H, Takakusaki H. Preoperative virtual simulation of adrenal tumors. ACTA ACUST UNITED AC 2008; 34:113-20. [DOI: 10.1007/s00261-008-9364-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kwan TL, Lam CM, Yuen AWC, Lo CY. Adrenalectomy in Hong Kong: a critical review of adoption of laparoscopic approach. Am J Surg 2007; 194:153-8. [PMID: 17618794 DOI: 10.1016/j.amjsurg.2006.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 11/07/2006] [Accepted: 11/07/2006] [Indexed: 12/22/2022]
Abstract
BACKGROUND A population-based study on adrenal surgery for treatment of adrenal diseases is still lacking. The aim of the present study is to evaluate the practice and the adoption of laparoscopic adrenalectomy (LA) in a stable population, as well as the potential impact of case volume on outcomes. METHODS Patients undergoing elective adrenalectomy (n = 486) from 15 Hong Kong public hospitals over a 6-year period were reviewed. Patients undergoing LA (n = 353) were compared to those undergoing open adrenalectomy (n = 133). RESULTS The overall number of adrenalectomies and the number and proportion of laparoscopic approach increased progressively during this period. The median operating time was similar but the median blood loss (50 mL vs 300 mL, P < .01) was less and the mean hospital stay (4.4 days vs 9.4 days) was shorter for LA. Smaller lesions tended to be selected for LA. There was no correlation between postoperative outcome with respect to length of stay and case volume for LA. CONCLUSIONS The adoption of LA in Hong Kong hospitals was propagating progressively. Patients selected for LA had improved outcome although there seemed to be no significant correlation between postoperative outcome and case volume.
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Affiliation(s)
- Tim Lok Kwan
- Central Surgical Audit Unit, Hospital Authority, 147B Argyle Street, Kowloon, Hong Kong, China.
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Strong VE, D'Angelica M, Tang L, Prete F, Gönen M, Coit D, Touijer KA, Fong Y, Brennan MF. Laparoscopic adrenalectomy for isolated adrenal metastasis. Ann Surg Oncol 2007; 14:3392-400. [PMID: 17665267 DOI: 10.1245/s10434-007-9520-7] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 06/13/2007] [Accepted: 06/14/2007] [Indexed: 12/25/2022]
Abstract
BACKGROUND Use of laparoscopy for isolated adrenal metastases is controversial. The aims of this study were to characterize patients with isolated adrenal metastases; compare operative characteristics of the laparoscopic adrenalectomy (LA) versus open adrenalectomy (OA) approach; and compare long-term oncological and surgical outcomes. METHODS Our adrenal resection database (1995-2006) identified 63 OA and 31 LA cases done for isolated adrenal metastases. Subset analysis was performed for all patients from isolated lung metastases (n = 39) and for all tumors smaller than 4.5 cm (n = 49). RESULTS Overall, local recurrence was 17%, median survival 30 months and 5-year estimated survival 31%. The only independent predictor of survival for all (n = 94) was adrenal tumor size less than 4.5 cm (P = 0.01). When comparing LA with OA, no differences in local recurrence, margin status, disease-free interval or overall survival were observed for the entire group, or for patients with metastases only from lung cancer (n = 39) or for those with tumors smaller than 4.5 cm (n = 49). LA provided significantly shorter operative time (175 vs 208 min, P = 0.04), lower estimated blood loss (EBL) (106 vs 749 cc, P < 0.0001), shorter length of hospital stay (2.8 vs 8.0 days, P < 0.0001) and fewer total complications (P < 0.0001). CONCLUSIONS LA is equivalent to OA in terms of margin status, local recurrence, disease-free interval and overall survival. LA for metastatic adrenal lesions is safe, with equivalent long-term oncological outcomes providing the additional benefits of a minimally invasive technique. LA can be recommended as an appropriate initial approach for isolated adrenal metastases.
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Affiliation(s)
- Vivian E Strong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Modi P, Goel R, Kadam G. Case Report: Retroperitoneoscopic Partial Adrenalectomy for Large Adrenocortical Oncocytoma. J Endourol 2007; 21:419-22. [PMID: 17451335 DOI: 10.1089/end.2006.0222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A young woman had mild hypertension, and on evaluation, a large tumor arising from the right adrenal gland was found. The tumor was hormonally inactive. Retroperitoneoscopic partial adrenalectomy was carried out. The histopathology report described adrenocortical oncocytoma.
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Affiliation(s)
- Pranjal Modi
- Department of Urology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India
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Abstract
In this article the authors have attempted to summarize and evaluate the current literature regarding the feasibility and indications of the laparoscopic approach to the resection of adrenal lesions. The overall results suggest that laparoscopic adrenalectomy is safe, effective, and has major advantages for patients in terms of decreased pain, hospital stay, and short- and long-term morbidity. For large and malignant lesions, good judgment and careful consideration must be given to the entire clinical picture so that the laparoscopic approach is used for patients who will derive benefits from the minimally invasive approach without compromising an oncologically sound resection or safety of operation. Additional studies will help clarify these remaining controversies further. The laparoscopic approach for adrenalectomy has demonstrated that significant and beneficial advances in surgery are improving the care offered patients.
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Affiliation(s)
- Charlotte Ariyan
- Department of Surgery, Memorial Sloan-Kettering Hospital, 1275 York Avenue, New York, NY 10021, USA
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Lee JN, Kim HT, Kwon TG. Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma: A Comparison with Open Nephroureterectomy. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.4.371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jun Nyung Lee
- Department of Urology, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Gyun Kwon
- Department of Urology, College of Medicine, Kyungpook National University, Daegu, Korea
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Bibliography. Current world literature. Minimally invasive surgery in urology. Curr Opin Urol 2006; 16:112-7. [PMID: 16479214 DOI: 10.1097/01.mou.0000193398.85092.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Weston AP. Can deep freezing join the endoscopic Barrett's mucosal ablation party? Cautious optimism is warranted. Gastrointest Endosc 2005; 62:849-52. [PMID: 16301024 DOI: 10.1016/j.gie.2005.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2005] [Accepted: 08/29/2005] [Indexed: 12/10/2022]
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LiteratureWatch. J Endourol 2005; 19:1045-62. [PMID: 16253079 DOI: 10.1089/end.2005.19.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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