Adrenal-sparing surgery: current concepts on a theme from the past

Perysinakis, Iraklis; Aggeli, C.; Kaltsas, G; Zografos, George

doi:10.1007/s42000-020-00202-0

Cited by 18 publications

(23 citation statements)

References 74 publications

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“…Additionally, treating patients with synchronous bPHEOs can be challenging, and no uniform standard surgical approach (for neither synchronous nor metachronous) has been established. Following laparoscopic device innovation, the accumulation of sufficient experience, and proficient surgical skills, synchronous surgery including SB-LCSA was increasingly used in clinical practice for treating these bPHEOs (10,(15)(16)(17)(18)(19)(20)(21)(22)(23)41). Walz et al (16) have reported that 15 patients with bPHEOs (average tumor size of 4.6 cm; 2 cases of recurrent PHEOs on one side) underwent synchronous bilateral laparoscopic adrenalectomy, in which 14 (93.3%) bilateral tumors were removed under the same anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous bilateral laparoscopic cortical-sparing adrenalectomy for bilateral pheochromocytomas in multiple endocrine neoplasia type 2

Lian²,

Fang³

et al. 2023

Front. Surg.

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PurposeThis study aimed to assess the feasibility of synchronous bilateral laparoscopic or open cortical-sparing adrenalectomy (SB-LCSA or SB-OCSA) for bilateral pheochromocytomas (bPHEOs) in multiple endocrine neoplasia type 2 (MEN2).MethodsAltogether, 31 patients (54.8% were women) were diagnosed with MEN2-related bPHEOs, and 29 of them underwent varying specific adrenalectomies. We systematically analyzed and evaluated their clinical profiles, mutation types, tumor histopathological features, and follow-up records.ResultsAll 31 patients with bPHEOs presented with RET-C634 (90.3%) and RET-M918T (9.7%) mutations, and the median age at initial presentation was 38 years (range, 23–78). bPHEOs were synchronous in 27 patients and metachronous in 4 (12.9%) patients. In total, 29 patients underwent initial cortical-sparing adrenalectomy (CSA) including 23 (79.3%) undergoing synchronous bilateral CSA (18 SB-LCSA and 5 SB-OCSA) and 6 (20.7%) undergoing metachronous CSA. SB-LCSA and synchronous surgery were associated with less bleeding volume and shorter length of hospital stay than SB-OCSA and metachronous surgery (all P’s < 0.05). Corticosteroid replacement treatment was necessary for 14 patients (45.2%) after bilateral CSA. During a median follow-up period of 7 years (range, 1.8–23), three of these patients (10.3%) had a recurrent disease that required reoperation.ConclusionSB-LCSA is feasible for treating synchronous bPHEOs and should be recommended as a prioritized surgical approach.

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Section: Discussionmentioning

confidence: 99%

Simultaneous bilateral laparoscopic cortical-sparing adrenalectomy for bilateral pheochromocytomas in multiple endocrine neoplasia type 2

Lian²,

Fang³

et al. 2023

Front. Surg.

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“…If the dosage is insufficient, patients are at risk for an Addisonian crisis, while too high of a dosage might lead to obesity, osteoporosis, hypertension, and diabetes. Patients need adequate dosage adjustment during physically or mentally stressful events and they are at risk for over-or under-treatment of steroids, which may induce inappropriate steroid hormone replacement [36].…”

Section: Partial Adrenalectomymentioning

confidence: 99%

“…However, even with laparoscopic magnified inspection, there has been debate regarding the identification of a distinct boundary layer between the medulla and cortical tissue, as well as whether it is possible to ensure complete removal of pure medullary tissue while leaving cortical adrenal tissue in situ. Therefore, from the perspective of organsparing surgery, the current concept of "partial" adrenalectomy is more widely used than that of "cortical-sparing" adrenalectomy [36].…”

Section: Surgical Procedures For Partial Adrenalectomymentioning

confidence: 99%

“…Unlike conventional total adrenalectomy, in partial adrenalectomy, the operator leaves a small amount of normal adrenal tissue, which is sufficient to maintain the adequate function of the adrenal gland, thereby minimizing the risk of lifelong steroid hormone supplementation and its complications, including Addisonian crisis [47]. Regarding the amount of residual adrenal tissue needed to maintain adrenal function, prior studies have demonstrated that approximately one-third of a unilateral adrenal gland is sufficient to maintain adrenal function [36]. Another author reported that at least 3 to 5 mm of residual adrenal tissue is required to sustain physiological adrenal function and to avoid steroid replacement.…”

Section: Surgical Procedures For Partial Adrenalectomymentioning

confidence: 99%

“…Therefore, it remains unclear whether preservation of the adrenal vein in partial adrenalectomy is essential. However, if it is possible to save the adrenal vein during complete removal of an adrenal tumor, it is suggested to preserve the adrenal vein [36].…”

Section: Surgical Procedures For Partial Adrenalectomymentioning

confidence: 99%

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Minimally Invasive Adrenal Surgery

Kwak

Lee

2020

Endocrinol Metab

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Since the introduction of minimally invasive surgery, laparoscopic adrenalectomy has become the main treatment option for adrenal masses. Various studies have reported that laparoscopic adrenalectomy showed fewer postoperative complications and faster recovery than conventional open adrenalectomy. Laparoscopic adrenalectomy can be performed through either the transperitoneal approach or the retroperitoneoscopic approach, which are widely used in most adrenal surgical procedures. Furthermore, with the development of minimally invasive surgery, organ-sparing adrenalectomy has recently emerged as a way to conserve functional adrenal gland tissue. According to recent data, organ-sparing adrenalectomy shows promising surgical, functional, and oncological outcomes including less intraoperative blood loss, maintenance of adrenal function, and low recurrence. Partial adrenalectomy was initially proposed for bilateral adrenal tumors in patients with hereditary disease to avoid chronic adrenal insufficiency. However, it has also gained popularity for the treatment of unilateral adrenal disease involving a small adrenal tumor because even patients with a unilateral adrenal gland may develop adrenal insufficiency in stressful situations. Therefore, partial adrenalectomy has become increasingly common to avoid lifelong steroid replacement and recurrence in most cases, especially in bilateral adrenal disease. This review article evaluates the current evidence on minimally invasive adrenalectomy and organ-preserving partial adrenalectomy.

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