Endoscopic treatment of large primary adrenal tumours

Background: For tumours of the adrenal gland different surgical retroperitoneal approaches have been established, including the lateral and the dorsal approach. It is still unclear if the lateral or the dorsal approach should be preferred. Patients and Methods: A retrospective comparison between 21 patients who underwent retroperitoneoscopic adrenalectomy in lateral position (LRA) and 24 patients who underwent a retroperitoneoscopic adrenalectomy in dorsal position (DRA). Results: There were no significant differences with regard to the age, sex, tumour localisation, and the size of the tumour. The body-mass-index as well as the operation time was significantly higher of patients who underwent surgery in lateral position. Complications were comparable in both groups. Conclusion: The dorsal and the lateral retroperitoneal approach are ideal approaches for patients having had an intraabdominal surgery before. Due to the missing intraabdominal pressure the lateral approach is advantageous for patients with high body-mass-index (>35) and is indicated for patients with a tumour >6 cm due to the small retroperitoneal space.

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“…The irritation of the subcostal nerve in our study was comparable to the subcostal nerve irritation described in the literature [8,13,18,19].…”

Section: Discussionsupporting

confidence: 89%

“…Journal of Surgical Oncology DOI 10.1002/jso Today, tumours of the adrenal gland with a size over 6 cm have already been operated transperitoneal laparoscopically or retroperitoneoscopically in dorsal position [9,19].…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneoscopic adrenalectomy: Lateral versus dorsal approach

Agha

Breitenbuch

Gahli

et al. 2007

Journal of Surgical Oncology

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“…Many retrospective studies demonstrate its association with less intraoperative blood loss, lower postoperative morbidity, a shorter hospital stay, greater patients satisfaction and fewer incisional hernia [37][38][39][40][41][42][43][44][45][46][47][48]. At the moment still controversy exsits about the appropriate surgical approach for tumors larger than 6 cm.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…The maximum tumor size able to be successfully resected by LA is highly dependant on the skill of the surgeon [37][38][39][40][41][42][43][44][45][46][47][48]. Laparoscopic surgery performed for adrenal tumors >6 cm or for tumors that are preoperativley considered potentially malignant should be performed by an experienced laparoscopic surgeon.…”

Section: Treatment Optionsmentioning

confidence: 99%

Bilateral Primary Adrenal Non-Hodgkin's Lymphoma and Primary Adrenocortical Carcinoma - Review of the Literature Preoperative Differentiation of Adrenal Tumors

Ozimek¹,

Diebold

Linke³

et al. 2008

Endocr J

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Abstract. Most of the adrenal tumors that are incidentally detected are benign adenomas. The incidence of malignant adrenal tumors including adrenocortical carcinoma (ACC) and primary adrenal lymphoma (PAL) is rather low. As many patients with ACC and PAL are diagnosed at an advanced stage of disease, the overall survival time of both entities remains poor. The therapeutic strategies for both entities differ. Thus an early differentiation between ACC and PAL is necessary. Unfortunately hitherto preoperative diagnosis of potentially malignant adrenal masses is still a main problem in the treatment of adrenal tumors. We present the case of a 57-year-old male patient with ACC and the case of an 87-year-old male patient with PAL and provide a systematic comparison of the clinical and pathological features of both entities. In both cases clinical and radiological features resulted in an initially false diagnosis. Primary surgical therapy was performed in both patients. The patient with PAL died five months aftre initial surgery. The patient with ACC showed tumor progression with local and systemic recurrence despite adjuvant therapy with mitotane and additional surgical therapy. Prognosis of patients with ACC and PAL seems to be dependant on the ability to start accurate treatment without any time delay. We propose some guidelines for diagnosis and surgical management of adrenal tumors.

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“…Apart from complications, tumour size, and underlying pathology are important factors effective on the conversion to open surgery. Walz et al [22] detected that tumor size greater than 6 cm in diameter decreased the probability of completion of the surgery by laparoscopic technique. Besides, unpredicted adhesions of the mass undetectable in CT or MR to surrounding tissues may be another reason necessitating conversion to open surgery.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic transperitoneal adrenalectomy: Our initial results

Özgör

Binbay

Akbulut

et al. 2014

Turkish Journal of Urology

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Objective: To present the first 24 laparoscopic adrenalectomies performed in our clinic because of an adrenal mass. Material and methods:The medical files of 24 patients who underwent laparoscopic adrenalectomy between December 2008 and March 2013 at Haseki Teaching and Research Hospital were analyzed retrospectively. The demographic characteristics of the patients were recorded. Lateral transperitoneal laparoscopic adrenalectomy was performed in all patients. The operation time was defined as the interval between the first incision of the skin and closure of the skin. Intraoperative complications, estimated blood loss and hospital stays of the patients were evaluated. Final pathologies were recorded. Results:The mean age of the patients was 44.2±8.58 years (range: 29-66 years). Nine patients were female and 15 were male. A total of 24 masses were identified in the right (n=11), and left (n=13) adrenal glands masses were identified., Eighteen patients (75%) had no symptoms, and the masses were identified incidentally. The mean operation time was 144±46.1 minutes (range: 90-320 minutes), and the mean blood loss was 74±12.3 mL (range: 50-130 mL). None of the patients required a blood transfusion. In one patient, liver injury was identified intraoperatively due to traction. The mean duration of hospitalization was 2.9±1.1 days (range: 2-5 days). Adrenocortical adenoma and pheochromocytoma were the most common pathologies. Conclusion:Laparoscopic adrenalectomy is a safe and effective method for the treatment of adrenal masses with low complication rates.

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Endoscopic treatment of large primary adrenal tumours

Abstract: Endocopic adrenalectomy perfomed by an experienced surgeon should be the treatment of choice for tumours exceeding 6 cm in diameter.

Cited by 85 publications

References 21 publications

Retroperitoneoscopic adrenalectomy: Lateral versus dorsal approach

Retroperitoneoscopic adrenalectomy: Lateral versus dorsal approach

Bilateral Primary Adrenal Non-Hodgkin's Lymphoma and Primary Adrenocortical Carcinoma - Review of the Literature Preoperative Differentiation of Adrenal Tumors

Laparoscopic transperitoneal adrenalectomy: Our initial results

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