Adrenal surgery in the pediatric population

Abstract

Adrenal tumors in children may be benign or malignant. In addition, both benign and malignant tumors may be hormonally active, leading to hypertension, metabolic crises, and endocrinopathies. These tumors may be found incidentally or secondary to signs and symptoms of the aforementioned disorders. Both a metabolic and a radiographic work-up are required before treatment of an adrenal tumor. The primary therapy for most adrenal lesions is surgical, though some are treated medically or require chemotherapy before excision. Laparoscopy has become the surgical approach of choice in both adult and pediatric patients with localized disease. Open surgical approaches remain necessary in patients with extensive locally invasive or metastatic disease.

Scope and limitations of minimal invasive surgery in practice of pediatric surgical oncology

“…Though there are specific pre-requisites for laparoscopic excision of neuroblastoma, there is a clear and definite role of MIS in excising these tumors in children. [23][24][25][26][27][28][29][30] Nephrectomy for Wilms' tumor is another common surgery performed in children. With preoperative chemotherapy, nephrectomy is possible using MIS and intraperitoneal morcellation of tumor may not be needed.…”

“…With preoperative chemotherapy, nephrectomy is possible using MIS and intraperitoneal morcellation of tumor may not be needed. [31] Several other tumors completely excised by laparoscopy reported in literature include adrenal tumors, [32][33][34][35] Altman tpe II-IV sacrococcygeal teratomas, [36] presacral ganglioneurofibroma [37] and ovarian teratomas (oophorectomy). [38][39][40] The resection of pheochromocytoma and even those arising from an extraadrenal site laparoscopically [34] proves that pediatric surgical oncology MIS has advanced and is finding more and more indications of its use.…”