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Mandelia A, Mayilvaganan S, Naik PB, Kanneganti P. Laparoscopic Transperitoneal Adrenalectomy for Adrenal Tumors in Children: Technical Considerations and Surgical Experience. J Laparoendosc Adv Surg Tech A 2024; 34:189-198. [PMID: 37862564 DOI: 10.1089/lap.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Aims: This study aimed to review our surgical experience of laparoscopic adrenalectomy (LA) for adrenal masses in the pediatric age group. Materials and Methods: The electronic medical records of all patients younger than 18 years of age who underwent LA between 2016 and 2023 were retrospectively reviewed. Children with adrenal tumors localized to the site of origin without evidence of encasement of major vasculature or involvement of adjacent organs were considered for LA. Patients with diagnosis of malignant adrenal tumor on preoperative work-up underwent open adrenalectomy. Data were collected regarding demography, clinical presentation, hormonal workup, imaging, duration of surgery, transfusion requirement, conversion rate, postoperative recovery, duration of intravenous (i.v.) analgesia and hospital stay, pathology, complications, and status at follow-up. Results: Between 2016 and 2023, LA adrenalectomy was performed in 11 patients (6 boys and 5 girls) with a mean age of 46.3 (8-120) months. A functional tumor was detected in 6 (54.5%) children, manifesting clinically with Cushing's syndrome (3), virilization (1), feminization (1), or Conn's syndrome (1). Seven (63.6%) tumors originated from the right adrenal, and 4 (36.4%) from the left adrenal gland. The mean tumor weight and size was 49.1 (10-80) g and 5.6 (3-8) cm, respectively. Histopathology included adrenal adenoma (5), ganglioneuroma (3), ganglioneuroblastoma (1), myelolipoma (1), and intermediate adrenocortical tumor (1). The mean surgery duration was 186.6 (120-265) minutes. Intraoperative blood transfusion was required in 2 (18.2%) patients and none required conversion. Full feeds were resumed at 42.7 (24-60) hours, i.v. analgesia requirement was for 54.5 (36-72) hours and mean hospital stay was 5.1 (3-8) days. All patients were symptom-free with no recurrence at mean follow-up period of 50.6 (3-83) months. Conclusions: In children with well-circumscribed, localized, and noninvasive adrenal tumors, LA is feasible, effective, and safe with all advantages of minimally invasive surgery.
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Affiliation(s)
- Ankur Mandelia
- Department of Pediatric Surgery and Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Sabaretnam Mayilvaganan
- Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Prathibha B Naik
- Department of Pediatric Surgery and Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Pujana Kanneganti
- Department of Pediatric Surgery and Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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Abstract
PURPOSE To analyze the role of laparoscopic surgery for the management of pediatric adrenal tumors (AT). METHODS Retrospective analysis of children diagnosed with AT, operated laparoscopically during 2003-2020. The strategy differed according to tumor extension. AT < 6 cm were resected. Locally advanced tumors (L2) or > 6 cm were biopsied. RESULTS N = 28. Complete tumor resection (R0) in 20 (71%), tumor biopsy in 8 (R2). Age (median): 28.8 months (2 months-18 years). 14/28 left-sided, 2 bilateral. Median operating time: 78 min (45-180). Mean tumor size (for resections): 4 cm (2.5-6). Tumor pathology: neuroblastoma (n = 17), Ganglioneuroma (n = 7), Adrenocortical carcinoma (n = 1), Osteosarcoma metastasis (n = 1), Pheochromocytoma (n = 1), Venous malformation (n = 1). Mean hospital stay: 2.5 days (1-3). Mean follow up: 65.5 months (24-192). Overall survival and event-free survival were 86 and 75%, respectively (5 years event-free survival for neuroblastoma: 33% [intermediate risk], 16.6% [high risk]. No surgery-related mortality. CONCLUSION Laparoscopic surgery for adrenal tumors is safe. Laparoscopic biopsy is useful for unresectable tumors when a percutaneous approach is not possible. With the proposed selection criteria, the laparoscopic approach should be the first option for resection of small and localized AT in pediatrics.
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Surgical Approaches to Neuroblastoma: Review of the Operative Techniques. CHILDREN-BASEL 2021; 8:children8060446. [PMID: 34070327 PMCID: PMC8227756 DOI: 10.3390/children8060446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022]
Abstract
Neuroblastoma (NB) is the most commonly occurring soft-tissue malignancy of childhood. Surgery plays an important role in multidisciplinary treatment and its principal aim is a local control of the disease, respecting the integrity of the surrounding structures. There is no unanimous consensus on the best surgical technique, and the operative approach largely depends on the anatomical location and the extension of the mass. To have a complete overview of the different type of treatment, we made a review of the literature from the last twenty years of all the surgical approaches applied for NBs resection, accordingly to the anatomical site.
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Affiliation(s)
- James K Moon
- Department of Surgery, The Mount Sinai Hospital, New York, NY
| | - Peter Mattei
- General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia.
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Dokumcu Z, Divarci E, Ertan Y, Celik A. Laparoscopic adrenalectomy in children: A 25-case series and review of the literature. J Pediatr Surg 2018; 53:1800-1805. [PMID: 29254846 DOI: 10.1016/j.jpedsurg.2017.11.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is the gold standard and is widely performed in adults, but its use in children is relatively new. We aim to present our experience in twenty-five children with diverse adrenal pathologies and to discuss an extensive review of pediatric LA in English literature. METHODS Medical records of children with adrenal tumors admitted to a tertiary center and treated with LA were reviewed. Characteristics and outcome of patients were compared with results of a systematic Pubmed/Medline literature review. RESULTS Transperitoneal LAs were performed for 12 malignant and 14 benign adrenal masses (size range: 2-8cm) in 25 children (median age:63months). Fourteen lesions were on the right side, and there was one bilateral case. There were no conversion and no complication within 36months of follow-up. A literature review revealed 437 pediatric LAs with left side predomination (51.4%). The indication was a malignant lesion in 60.2% of the cases (sizes range: 1-10cm). The transperitoneal route was preferred in 94.2% of the procedures. Conversion and complication rates were 7.5% and 3.1%, respectively. CONCLUSION LA should be preferred in selected children with adrenal pathologies. The transperitoneal route seems to be the standard approach for pediatric surgeons. Preoperative planning and surgical expertise are the keys to success. TYPE OF THE STUDY Case series with systematic literature review. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zafer Dokumcu
- Ege University Faculty of Medicine, Department of Pediatric Surgery, Izmir, Turkey.
| | - Emre Divarci
- Ege University Faculty of Medicine, Department of Pediatric Surgery, Izmir, Turkey.
| | - Yesim Ertan
- Ege University Faculty of Medicine, Department of Pathology, Izmir, Turkey.
| | - Ahmet Celik
- Ege University Faculty of Medicine, Department of Pediatric Surgery, Izmir, Turkey.
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Orofino A, Maggipinto C, Lanzillotto M, D'Amato M, Ronzini M, Paradies G. Laparoscopic treatment of adrenal masses in children: Report of two cases and review of literature. Afr J Paediatr Surg 2016; 13:98-102. [PMID: 27251661 PMCID: PMC4955444 DOI: 10.4103/0189-6725.182565] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Laparoscopic adrenalectomy has become a common alternative to open surgery for the resection of adrenal lesions in adults: The advantages are to provide better exposure of the adrenal gland, diminish soft tissue dissection, decrease morbidity and postoperative pain; however, reporting on the laparoscopic adrenalectomy in paediatric patients has been limited. We present two cases of laparoscopic adrenalectomy performed at our institution in two children, for left adrenal neuroblastoma in a first patient with opsomyoclonus syndrome, and for a right incidentaloma in the second case. According to recent literature, our experience has demonstrated that the laparoscopic adrenalectomy is a feasible procedure in children with small, well-circumscribed adrenal masses: It can be used a safety to treat suspected benign and malignant adrenal masses in children, with minimal morbidity and short hospital stay. The lateral trans-peritoneal approach offers optimal visualisation and good outcomes in terms of minimal discomfort, rapid recovery and excellent cosmesis. However, in the paediatric field, the number of patients is limited, making the learning curve longer.
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Affiliation(s)
- Antonio Orofino
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
| | - Cosetta Maggipinto
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
| | - MariaPaola Lanzillotto
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
| | - Michele D'Amato
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
| | - Massimo Ronzini
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
| | - Guglielmo Paradies
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
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Catellani B, Acciuffi S, Biondini D, Ceccarelli PL, Cacciari A, Gelmini R. Transperitoneal laparoscopic adrenalectomy in children. JSLS 2016; 18:JSLS-D-13-00388. [PMID: 25392674 PMCID: PMC4208910 DOI: 10.4293/jsls.2014.00388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: The use of a minimally invasive approach for adrenalectomy is poorly defined in pediatric patients, although laparoscopic adrenalectomy is considered a standard procedure in adults. The aim of our study was to describe the safety and feasibility of minimally invasive adrenalectomy in children on the basis of surgical skills and results. Materials and Methods: This was a retrospective study of 4 pediatric laparoscopic adrenalectomies performed at our center between 2009 and 2012. All patients underwent transperitoneal lateral laparoscopic adrenalectomies (2 right and 2 left adrenalectomies). Results: Four laparoscopic adrenalectomies were performed. Indications for surgery were neuroblastoma in 2 patients, secernent adrenocortical tumor in 1 patient, and adrenocortical nodular hyperplasia in 1 patient. Patients had a mean age of 87 months (range, 17–156 months) at diagnosis, and the average lesion size was 3.23 cm (range, 0.7–6.4 cm). All laparoscopic adrenalectomies were successful, no conversions to open surgery were required, and no postoperative complications or deaths occurred. The average operating time was 105 minutes (range, 80–130 minutes), blood loss during surgery was minimal, and the mean postoperative hospital stay was 3.75 days (range, 3–5 days). None of the patients showed signs of recurring disease at 15-month follow-up. Conclusions: Laparoscopic adrenalectomy is a safe, feasible, and reproducible technique offering numerous advantages, including shortening of operating times and postoperative hospital stays, as well as reduction of blood loss and complications. It also provides good visibility and easy access to other organs.
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Affiliation(s)
| | | | - Diego Biondini
- Department of Pediatric Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | - Pier Luca Ceccarelli
- Department of Pediatric Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | - Alfredo Cacciari
- Department of Pediatric Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
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Abstract
During recent years, minimally invasive surgery (MIS) has become the standard approach for various operations in infants and children. MIS in pediatric thoracic and abdominal tumors is a controversial approach in the surgical management of childhood cancer. Meanwhile, more and more oncological biopsies and resections are being performed laparoscopically or thoracoscopically. Despite its increasing role in pediatric tumor surgery, the different national and international multicenter trial groups have not yet implemented MIS within guidelines and recommendations in most of the current treatment protocols. An increasing number of retrospective reports describes a potential role of MIS in the management of different pediatric oncological entities. Over the time, there has been a diverse development of this approach with regard to the different neoplasms. Nevertheless, there is a lack of prospective randomized trails assessing MIS. This still represents a requirement for evidence-based medicine and judging the advantages and disadvantages of this approach. The purpose of this state-of-the-art article is to review the current literature to describe the application of MIS in pediatric solid tumors.
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Affiliation(s)
- Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany,
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Kelleher CM, Smithson L, Nguyen LL, Casadiego G, Nasr A, Irwin MS, Gerstle JT. Clinical outcomes in children with adrenal neuroblastoma undergoing open versus laparoscopic adrenalectomy. J Pediatr Surg 2013; 48:1727-32. [PMID: 23932613 DOI: 10.1016/j.jpedsurg.2013.03.056] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Laparoscopic resection of adrenal neuroblastoma has become a common alternative to open surgery. Prior reports have largely focused on short-term operative complications. This study compares long-term oncologic outcomes in children undergoing laparoscopic or open adrenalectomy for neuroblastoma. METHODS Seventy-nine patients at a single center met inclusion criteria for having adrenal neuroblastoma and undergoing operative resection. Patients were assigned to high or low/intermediate (L/I) risk groups based upon Children's Oncology Group (COG) trial enrollment. Criteria for laparoscopic resection were absence of vascular encasement and size ≤ 5 cm in greatest dimension. Comparison between open versus laparoscopic groups was performed by Wilcoxon ranked-sum and Fisher's exact test. Multivariate Cox proportional hazard models analyzed the primary outcomes of mortality and recurrence. RESULTS In the L/I risk category (N=30) there was one non-neuroblastoma related death in the open cohort. Six of 7 patients in the High risk Group who underwent laparoscopic resection had favorable outcomes. Only higher tumor stage (Hazard Ratio 8.455, P=0.01) and earlier tumor recurrence were associated with increased mortality (Hazards Ratio 0.932, P=0.0002). Among patients who met selection criteria for laparoscopic surgery there was no difference in mortality or recurrence rates between High risk and L/I risk. CONCLUSIONS Laparoscopic resection of adrenal neuroblastoma is feasible and can be performed with equivalent recurrence and mortality rates in L/I risk patients and selected High risk patients. These data suggest that laparoscopic resection of adrenal neuroblastoma should be considered in patients who meet selection criteria, irrespective of risk group categorization.
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Lopes RI, Dénes FT, Bissoli J, Mendonca BB, Srougi M. Laparoscopic adrenalectomy in children. J Pediatr Urol 2012; 8:379-85. [PMID: 21955529 DOI: 10.1016/j.jpurol.2011.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 07/18/2011] [Indexed: 12/23/2022]
Abstract
PURPOSE Reporting on the laparoscopic technique for adrenal disease in children and adolescents has been limited. We review here our experience with laparoscopic adrenal surgery in children. PATIENTS AND METHODS 19 laparoscopic unilateral adrenalectomies were performed in 10 girls and 7 boys (mean age 3.9 years) during 1998-2011. The clinical diagnosis before surgery was virilizing tumor (n = 8), pheochromocytoma (n = 3), nonfunctioning solid adrenal tumor (n = 3), mixed adrenocortical tumor (n = 2), cystic adrenal mass (n = 1). Unilateral adrenal lesions were 20-65 mm at the longest axis on computerized tomography (12 right side, 7 left side). RESULTS The final clinicopathological diagnosis was cortical adenoma (n = 9), pheochromocytoma (n = 3, bilateral in two), neuroblastoma (n = 1), ganglioneuroblastoma (n = 1), ganglioneuroma (n = 1), adrenocortical carcinoma (n = 1), benign adrenal tissue (n = 1). Average operative time was 138.5 min (range 95-270). Blood transfusion was required in one case (5%). No conversion to open surgery was required and no deaths or postoperative complications occurred. Average hospital stay was 3.5 days (range 2-15). Average postoperative follow-up was 81 months (range 2-144). Two contralateral metachronic pheochromocytomas associated with von Hippel-Lindau syndrome occurred, treated with partial laparoscopic adrenalectomy (one without postoperative need of cortisone replacement therapy). CONCLUSIONS Laparoscopic adrenalectomy is a feasible procedure that produces good results. It can be used safely to treat suspected benign and malignant adrenal masses in children with minimal morbidity and short hospital stay.
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Affiliation(s)
- Roberto Iglesias Lopes
- Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, Rua Dr. Enéas de Carvalho Aguiar, 455 - 7 andar, São Paulo, Brazil
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Kanthan R, Senger JL, Kanthan S. Three uncommon adrenal incidentalomas: a 13-year surgical pathology review. World J Surg Oncol 2012; 10:64. [PMID: 22540324 PMCID: PMC3407001 DOI: 10.1186/1477-7819-10-64] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 04/27/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The discovery of adrenal incidentalomas due to the widespread use of sophisticated abdominal imaging techniques has resulted in an increasing trend of adrenal gland specimens being received in the pathology laboratory. In this context, we encountered three uncommon adrenal incidentalomas.The aim of this manuscript is to report in detail the three index cases of adrenal incidentalomas in the context of a 13-year retrospective surgical pathology review. METHODS The three index cases were investigated and analyzed in detail with relevant review of the English literature as available in PubMed and Medline. A 13-year retrospective computer-based histopathological surgical review was conducted in our laboratory and the results were analyzed in the context of evidence-based literature on adrenal incidentalomas. RESULTS A total of 94 adrenal specimens from incidentalomas were identified, accounting for 0.025% of all surgical pathology cases. In all 76.6% were benign and 23.4% were malignant. A total of 53 females (56.4%) and 41 males (43.6%) aged 4 to 85 years were identified. The benign lesions included cortical adenoma (43.1%), pheochromocytoma (29.3%) and inflammation/fibrosis/hemorrhage (8.3%). Metastatic neoplasms were the most common malignant lesions (50%) followed by primary adrenocortical carcinomas (31.8%) and neuroblastoma (13.6%). These cases were discovered as adrenal incidentalomas that led to surgical exploration.The three index cases of adrenal incidentalomas with unusual pathologies were encountered that included (a) adrenal ganglioneuroma, (b) periadrenal schwannoma and (c) primary adrenal pleomorphic leiomyosarcoma. These cases are discussed, with a literature and clinicopathological review. CONCLUSIONS Adrenal lesions are uncommon surgical specimens in the pathology laboratory. However, higher detection rates of adrenal incidentalomas aided by the ease of laparoscopic adrenalectomy has resulted in increased adrenal surgical specimens leading to unsuspected diagnostic and management dilemmas. Accurate pathological identification of common and uncommon adrenal incidentalomas is essential for optimal patient management.
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Affiliation(s)
- Rani Kanthan
- Department of Pathology and Laboratory Medicine, Saskatoon, Saskatchewan, Canada
- Room 2868 G-Wing, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0 W8, Canada
| | - Jenna-Lynn Senger
- Department of Pathology and Laboratory Medicine, Saskatoon, Saskatchewan, Canada
| | - Selliah Kanthan
- Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Emergency management of hypertension in children. Int J Nephrol 2012; 2012:420247. [PMID: 22577545 PMCID: PMC3345222 DOI: 10.1155/2012/420247] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 12/13/2011] [Accepted: 01/12/2012] [Indexed: 12/18/2022] Open
Abstract
Systemic arterial hypertension in children has traditionally been thought to be secondary in origin. Increased incidence of risk factors like obesity, sedentary life-styles, and faulty dietary habits has led to increased prevalence of the primary arterial hypertension (PAH), particularly in adolescent age children. PAH has become a global epidemic worldwide imposing huge economic constraint on health care. Sudden acute increase in systolic and diastolic blood pressure can lead to hypertensive crisis. While it generally pertains to secondary hypertension, occurrence of hypertensive crisis in PAH is however rare in children. Hypertensive crisis has been further subclassified depending on presence or absence of end-organ damage into hypertensive emergency or urgency. Both hypertensive emergencies and urgencies are known to cause significant morbidity and mortality. Increasing awareness among the physicians, targeted at investigation of the pathophysiology of hypertension and its complications, better screening methods, generation, and implementation of novel treatment modalities will impact overall outcomes. In this paper, we discuss the etiology, pathogenesis, and management of hypertensive crisis in children. An extensive database search using keywords was done to obtain the information.
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Cho MJ, Kim DY, Kim SC, Kim TH, Kim IK. Adrenocortical tumors in children 18 years old and younger. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:246-50. [PMID: 22493766 PMCID: PMC3319779 DOI: 10.4174/jkss.2012.82.4.246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 02/02/2012] [Accepted: 02/07/2012] [Indexed: 11/30/2022]
Abstract
Purpose Pediatric adrenocortical tumors (ACTs) are rare. We reviewed findings in 8 children, 18 years of age or younger, diagnosed with ACT in our institution over the past 15 years. Methods We retrospectively reviewed 8 children with ACTs treated between 1996 and 2010. Results Three girls and 5 boys were treated for ACTs; their median age at presentation was 144 months (range, 28 months to 18 years). Seven patients showed signs of endocrine dysfunction, 4 with Cushing syndrome, 2 with virilization, and 1 with hyperaldosteronism. One patient, with symptoms of hematuria, underwent a computed tomography scan, which showed an adrenal mass. The median duration of symptoms prior to resection was 6 months (range, 1 to 24 months). Five patients had adenomas and 3 had carcinomas. All underwent complete resection of the tumor, with laparoscopic adrenalectomy performed on 3 patients with adenoma and 1 with carcinoma. The median tumor weight was 12.5 g (range, 1 to 130 g) and the median tumor volume was 18.3 cm3 (range, 2.2 to 299.2 cm3). At a median follow-up of 5.1 years (range, 4 months to 15 years), all 8 patients remain alive with no recurrence of disease. Conclusion The characteristics of pediatric ACTs vary considerably. Laboratory findings, clinical hormonal features, and tumor size could not distinguish adenomas from carcinomas before surgery. Complete tumor resection was successful, with no tumor recurrence. However, the small number of patients and short follow-up period limit assessments of prognosis.
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Affiliation(s)
- Min Jeng Cho
- Division of Pediatric Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Peter SDS, Valusek PA, Hill S, Wulkan ML, Shah SS, Ferro MM, Laje P, Mattei PA, Graziano KD, Muensterer OJ, Pontarelli EM, Nguyen NX, Kane TD, Qureshi FG, Calkins CM, Leys CM, Baerg JE, Holcomb GW. Laparoscopic Adrenalectomy in Children: A Multicenter Experience. J Laparoendosc Adv Surg Tech A 2011; 21:647-9. [DOI: 10.1089/lap.2011.0141] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | | | - Sarah Hill
- Department of Surgery, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Mark L. Wulkan
- Department of Surgery, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia
| | - Sohail S. Shah
- Department of Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marcello Martinez Ferro
- Department of Surgery, Fundacion Hospitalaria Children's Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Pablo Laje
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Peter A. Mattei
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | - Nam X. Nguyen
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, California
| | - Timothy D. Kane
- Department of Surgery, National Children's Hospital, Washington, District of Columbia
| | - Faisal G. Qureshi
- Department of Surgery, National Children's Hospital, Washington, District of Columbia
| | - Casey M. Calkins
- Department of Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Charles M. Leys
- Department of Surgery, Riley Children's Hospital, Indianapolis, Indiana
| | - Joanne E. Baerg
- Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, California
| | - George W. Holcomb
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Kim T, Kim DY, Cho MJ, Kim SC, Seo JJ, Kim IK. Use of laparoscopic surgical resection for pediatric malignant solid tumors: a case series. Surg Endosc 2010; 25:1484-8. [DOI: 10.1007/s00464-010-1418-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 08/29/2010] [Indexed: 10/18/2022]
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