Hazards of laparoscopic adrenalectomy for Conn's adenoma

Abstract

A 74-year-old man with primary aldosteronism had a small tumor (27 x 23 mm) of his right adrenal gland successfully removed by a transperitoneal laparoscopy. Despite absence of malignancy in the resected tumor and complete relief of all symptoms in the immediate postoperative period, recurrence occurred 6 months later. The tumor behaved as a carcinoma spread in the peritoneal cavity, and the patient eventually died with peritoneal carcinomatosis. We suggest that the laparoscopic technique coupled with pneumoperitoneum may have favored this recurrence.

Adrenocortical carcinoma: is the surgical approach a risk factor of peritoneal carcinomatosis?

“…They however did not compare open surgery to laparoscopic surgery, and only included four ACC patients among whom one needed a conversion to an open procedure and one developed a pelvic 18-cm recurrence 6 months after initial surgery that was compatible with PC. Of note, clinical cases of PC occurring in ACC patients after LA were recently reported (35)(36)(37).…”

Endoscopic Retroperitoneal Adrenalectomy: Lessons Learned From 111 Consecutive Cases

“…A second laparotomy was undertaken to excise all tumor deposits and to install intraperitoneal chemotherapy, which was followed by intravenous chemotherapy. Foxius et al 16 observed peritoneal carcinomatosis 6 months after laparoscopic removal of a right 2.7-cm aldosterone-producing adrenal lesion. Despite splenectomy and omentectomy followed by mitotane chemotherapy, the patient died 20 months after surgery.…”

“…To our knowledge, three other cases of recurrence of adrenal cancer after laparoscopic adrenalectomy have been reported. [15][16][17] Hamoir et al 15 described a patient with a 12-cm androgenproducing right adrenal tumor that had been removed through a subcostal laparotomy after 4 hours of troublesome laparoscopic dissection. Diffuse peritoneal adrenal cancer was found at follow-up.…”

Current Approaches in the Minimally Invasive Surgical Treatment of Adrenal Tumors

“…Recent data from the literature confirm that laparoscopic adrenalectomy is safe and effective for malignant adrenal tumors. In some studies, outcome results with regard to peritoneal carcinomatosis, positive resection margins, and time to recurrence showed no statistically significant differences between open and laparoscopic approaches [12,[28][29][30][31][32][33]. In other studies with regard to ACC, oncologic outcomes of laparoscopic adrenalectomy were not comparable to open adrenalectomy [17,34,35].…”