A case of port-site recurrence after laparoscopic adrenalectomy for solitary adrenal metastasis

Track recurrence after remote-access thyroid surgeries: A systematic review

BACKGROUND

Remote-access thyroidectomies have gained popularity, but track recurrence, which is the implantation of thyroid tissue or lesions along the surgical access route, has been reported in case studies. This systematic review aims to review cases of track recurrence following remote-access thyroidectomies.

METHODS

A comprehensive literature search was conducted using PubMed, the Web of Science, the Cochrane Library, and Google Scholar to identify case reports on track recurrence after endoscopic or robotic thyroidectomy up to June 2024. Data included patient demographics, details of the initial surgery and diagnosis, methods and timing of recurrence detection, and management strategies.

RESULTS

The search yielded 1578 articles, of which 17 case reports comprising 18 patients were included. The patients (16 females and two males) had a mean age of 34.6 ± 14.9 years. The mean size of initial tumors was 3.9 ± 1.2 cm, with diagnoses of eight cancers and 10 benign lesions. The initial surgeries included 12 endoscopic and six robotic procedures. Track recurrence was most often detected by palpable nodules followed by routine imaging and elevated serum Tg levels. The interval between initial surgery and recurrence ranged from 3 months to 8 years. Management varied from surgical resection and radioactive iodine therapy to close observation. There were no further recurrences in all but one case postoperatively.

CONCLUSION

Track recurrence after remote-access thyroidectomy is rare but significant. Proper surgical techniques, careful handling of thyroid tissue, and rigorous postoperative monitoring are essential to minimize this risk. Awareness and prompt management of track recurrence may lead to favorable outcomes.

Port-Site Implantation Diagnosed by Iodine-131 Post-Ablation Single-Photon Emission Tomography-Computed Tomography After Robotic Thyroidectomy: A Case Report

Patient: Female, 37

Final Diagnosis: Port-site implantation after robotic thyroidectomy

Symptoms: None

Medication: —

Clinical Procedure: Iodine-131 post-ablation whole body scan and single photon emission tomography-computed tomography

Specialty: Nuclear Medicine

[Adrenalectomy for adrenal metastases: is the laparoscopic approach beneficial for all patients?]

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.

Laparoscopic adrenalectomy for cancer

Laparoscopic procedures are preferred by surgeons and patients alike because of decreased pain, reduced perioperative morbidity, and an earlier return to self-reliance. During the last decade, laparoscopic adrenalectomy has become the technique most commonly used for the removal of benign adrenal tumors. The indications for laparoscopy in malignant adrenal tumors remains controversial, because oncologic resections have not been reproducible compared with open techniques.

Minimally invasive adrenalectomy in children

PURPOSE

Minimally invasive adrenalectomy (MIA) is the criterion standard for removal of small adrenal tumors in adults. The purpose of this review was to determine the place of MIA in children.

METHODS

The authors conducted a systematic review of the pediatric and adult literature about MIA, focusing on the technique and indications.

RESULTS

Minimally invasive adrenalectomy appears superior to open adrenalectomy for small tumors. The potential advantages of MIA are appealing for postoperative pain, risk of intestinal obstruction, and quality of scars. The most common approach is the transperitoneal lateral laparoscopy, which allows for a large working space. For small tumors or for bilateral adrenalectomy, the prone retroperitoneoscopy is a promising new technique. In children, the learning curve is an issue because the indications are rare. The most common indication is neuroblastoma without image-defined surgical risk factors. The incidence of local recurrence is low, but the follow-up is short in most cases.

CONCLUSIONS

Minimally invasive adrenalectomy is promising for removal of small adrenal tumors. Long-term follow-up is required to evaluate the efficacy of MIA in neuroblastomas. Benign diseases are excellent candidates for this minimally invasive technique.

Surgical management of metastatic adrenal tumors: Decision-making factors in imaging

The present study aimed to clarify decision-making factors based on imaging for laparoscopic adrenalectomy (LA) or open adrenalectomy (OA) for adrenal metastasis (AM) based on our previous experience. From November 2003 to November 2006, 11 adrenalectomies were performed for AM for malignancies such as lung cancer, renal cell carcinoma (RCC) and breast cancer at Tokai University Hospital. A diagnosis of AM for these malignancies was suspected whenever a newly diagnosed adrenal mass was located, characterized by a basal computed tomography (CT) density superior to 10 Hounsfield units, strong or heterogeneous vascular enhancement following contrast injection and/or increasing size in sequential imaging studies. There was no evidence of extra-AM. The approach to surgical management using LA or OA was determined on the basis of CT and/or magnetic resonance imaging. The patients were reviewed every 2 or 3 months by physical examination and systemic CT. We analyzed the decision-making factors based on imaging for surgical management with LA or OA from the results of oncological outcome, imaging, intraoperative and pathohistological findings. In this study, 9 patients underwent 11 adrenalectomies (9 laparoscopic and 2 open procedures). Non-small cell lung cancer was the most common primary malignancy (5 adrenalectomies of 4 patients), followed by RCC (4 adrenalectomies of 4 patients) and breast cancer (2 adrenalectomies of 1 patient). The median tumor size for the LA group was 3.1±0.7 cm (range 2.1-4.3) and for the OA group, 6.1±0.8 cm (5.5 and 6.7 cm) (p=0.001). The operative time for the LA group was 127±42 min (range 90-215) and for the OA group, 224±47 min (190 and 257 min) (p=0.018). Blood loss for the LA group was 49±63 g (range 3-207) and for the OA group, 340±10 g (333 and 347 g) (p<0.001). No complications were noted and no conversion of LA to OA occurred. All 9 adrenal tumors selected for LA were removed safely without strong adhesion to the surrounding tissue. Two adrenal tumors removed by OA had a strong adhesion to the surrounding tissue. All 9 patients had complete resection, without capsular disruption and a negative margin in the pathological findings. No port-site and local recurrences occurred. No patients presented with local relapse or port-site metastasis. Disease-free survival rate for the LA group was 57% and for the OA group, 50% (p=0.661). LA is a less invasive treatment than OA for AM. However, for complete resection, OA should be selected for cases where resection by LA is difficult. Therefore, in the decision making towards the appropriate surgical management with LA or OA, it is important to closely assess pre-operative imaging. Imaging features supporting OA include no detection of fatty tissue between the tumor and proximal organs, tumors with an irregular contour, large tumors and tumors with a cystic component.

Thyroid cancer that developed around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy via a breast approach

Endoscopic thyroidectomy is gaining greater acceptance because of its excellent cosmetic result. As the surgical skill and understanding of the endoscopic cervical anatomy has improved, the surgical indications for endoscopic thyroidectomy have recently expanded to small size thyroid cancer. Despite the many advantages of laparoscopic surgery, there have been incidental reports about recurrences at the site of insertion of the laparoscope or other instruments in other cancers. Herein, we present a case of 25-year-old woman who had recurrent cancers around the operative bed and subcutaneous tunnel after endoscopic thyroidectomy.

Laparoscopic radical adrenalectomy for cancer: long-term outcomes

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.