Does laparoscopic adrenalectomy jeopardize oncologic outcomes for patients with adrenocortical carcinoma?

Cooper, Amanda; Habra, Mouhammed Amir; Grubbs, Elizabeth G.; Bednarski, Brian Keith; Ying, Anita K.; Perrier, Nancy D.; Lee, Jeffrey E.; Aloia, Thomas A.

doi:10.1007/s00464-013-3034-0

Cited by 108 publications

(99 citation statements)

References 23 publications

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“…Nine cohort studies on the surgical treatment of patients with nonmetastatic adrenocortical carcinoma were included (151,152,153,154,155,156,157,158,159). Three studies reported on the patients in whom complete resection of the tumor was achieved (153,155,159).…”

Section: Surgical Approach: Open Vs Minimally Invasive Adrenalectomy mentioning

confidence: 99%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,335

1,571

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By definition, an adrenal incidentaloma is an asymptomatic adrenal mass detected on imaging not performed for suspected adrenal disease. In most cases, adrenal incidentalomas are nonfunctioning adrenocortical adenomas, but may also represent conditions requiring therapeutic intervention (e.g. adrenocortical carcinoma, pheochromocytoma, hormone-producing adenoma or metastasis). The purpose of this guideline is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with adrenal incidentalomas based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions crucial for the management of adrenal incidentaloma patients, addressing these four with systematic literature searches: (A) How to assess risk of malignancy?; (B) How to define and manage low-level autonomous cortisol secretion, formerly called 'subclinical' Cushing's syndrome?; (C) Who should have surgical treatment and how should it be performed?; (D) What follow-up is indicated if the adrenal incidentaloma is not surgically removed? Selected recommendations: (i) At the time of initial detection of an adrenal mass establishing whether the mass is benign or malignant is an important aim to avoid cumbersome and expensive follow-up imaging in those with benign disease. (ii) To exclude cortisol excess, a 1 mg overnight dexamethasone suppression test should be performed (applying a cut-off value of serum cortisol ≤50 nmol/L (1.8 µg/dL)). (iii) For patients without clinical signs of overt Cushing's syndrome but serum cortisol levels post 1 mg dexamethasone >138 nmol/L (>5 µg/dL), we propose the term 'autonomous cortisol secretion'. (iv) All patients with '(possible) autonomous cortisol' secretion should be screened for hypertension and type 2 diabetes mellitus, to ensure these are appropriately treated. (v) Surgical treatment should be considered in an individualized approach in patients with 'autonomous cortisol secretion' who also have comorbidities that are potentially related to cortisol excess. (vi) In principle, the appropriateness of surgical intervention should be guided by the likelihood of malignancy, the presence and degree of hormone excess, age, general health and patient preference. (vii) Surgery is not usually indicated in patients www.eje-online.org European Journal of Endocrinology175:2 G2 Clinical Practice Guideline M Fassnacht and others ESE and ENSAT guideline on adrenal incidentalomawith an asymptomatic, nonfunctioning unilateral adrenal mass and obvious benign features on imaging studies. We provide guidance on which surgical approach should be considered for adrenal masses with radiological findings suspicious of malignancy. Furthermore, we offer recommendations for the follow-up of patients with adrenal incidentaloma who do not undergo adrenal surgery, for those with bilateral incidentalomas, for patients with extra-adrenal malignancy and adrenal masses and for young and elderly patients with adrenal inciden...

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Section: Surgical Approach: Open Vs Minimally Invasive Adrenalectomy mentioning

confidence: 99%

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Fassnacht

Arlt

Bancos

et al. 2016

European Journal of Endocrinology

1,335

1,571

View full text Add to dashboard Cite

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“…B. Cooper и соавт. предпочтение отдается открытой хирургии, так как данный вид доступа увеличивает безрецидивную вы-живаемость в группе открытых оперативных вмеша-тельств по сравнению с лапароскопической хирургией [23,24].…”

Section: Discussionunclassified

Surgical treatment of adrenal tumors

Толкачев¹,

Muradyan²,

Vorobyov³

et al. 2016

Androl. genit. hir.

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“…In this case, the open approach facilitated complete mobilization of the liver and vena cava with an en bloc resection of the tumor with surrounding soft tissues and no violation of the capsule. This technique limits the possibility of peritoneal seeding, which is more frequently observed after minimally invasive adrenalectomies (5).…”

Section: Case Reportmentioning

confidence: 99%

De Novo Development Of A Cortisol-Producing Adrenocortical Carcinoma In A Patient With Primary Adrenal Insufficiency

Khan

Waguespack

Aloia

et al. 2017

AACE Clinical Case Reports

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Objective: This case report describes the unusual transition from primary adrenal insufficiency to adrenocorticotropic hormone (ACTH)-independent Cushing syndrome (CS) associated with adrenocortical carcinoma (ACC).Methods: We report the clinical, laboratory, imaging, and pathological findings from a 57-year-old man with a history of primary adrenal insufficiency (Addison disease) who subsequently developed endogenous ACTHindependent CS associated with ACC.Results: Eight years after the patient was diagnosed with Addison disease, he developed features of CS, which led to cessation of the steroid replacement therapy he had been taking for his adrenal insufficiency. Hormonal tests, performed while the patient was not receiving corticosteroids, revealed elevated 24-hour urinary free cortisol (458 μg/24 h) and suppressed plasma ACTH. Computed tomography of the abdomen revealed a 10-cm heterogeneous right adrenal mass that did not exist on imaging studies performed 8 years earlier.The patient underwent open resection with pathological confirmation of ACC (Weiss score of 8 and Ki-67 labeling index of 19%). After surgery, the patient's CS resolved, and adjuvant mitotane therapy was initiated.Conclusions: We describe a unique case of transition from Addison disease without an adrenal mass to CS associated with ACC. This case illustrates the de novo development of ACC rather than ACC developing from a preexisting adrenal mass. The molecular changes leading to de novo ACC development were not examined in this report and warrant further research. (AACE Clinical Case Rep. 2017;3:e162-e165) Abbreviations: ACC = adrenocortical carcinoma; ACTH = adrenocorticotropic hormone; CS = Cushing syndrome; CT = computed tomography

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Does laparoscopic adrenalectomy jeopardize oncologic outcomes for patients with adrenocortical carcinoma?

Cited by 108 publications

References 23 publications

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors

Surgical treatment of adrenal tumors

De Novo Development Of A Cortisol-Producing Adrenocortical Carcinoma In A Patient With Primary Adrenal Insufficiency

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