Laparoscopic adrenalectomy for malignant lesions: surgical principles to improve oncologic outcomes

Sroka, Gideon; Slijper, Nadav; Shteinberg, Dan; Mady, Husam; Galili, Ofer; Matter, Ibrahim

doi:10.1007/s00464-012-2772-8

Cited by 16 publications

(16 citation statements)

References 19 publications

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“…The authors claim that the key element in surgery for any malignancy is not the surgical access itself but the proper technique. Similar results were shown by Sroka et al [27]. He concluded that the size of the lesion alone should not be an indication for open surgery and laparoscopy for adrenal malignancy is safe when basic oncological principles are applied.…”

Section: Discussionsupporting

confidence: 76%

“…In our series of tumors >6 cm, we found only 4 (4.5%) cases of ACC. Similarly, such low incidence can be found elsewhere [27]. Close adherence to the principle of using only open approach in case of tumors >6 cm would deprive 95% of patients the benefits of laparoscopic operation exposing them unnecessarily to higher complication rate, slower recovery, more postoperative pain and other disadvantages of open surgery [1,2].…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Transperitoneal Lateral Adrenalectomy for Large Adrenal Tumors

Natkaniec¹,

Pędziwiatr²,

Wierdak³

et al. 2016

Urol Int

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Background: Laparoscopic adrenalectomy is the gold standard for treatment of benign adrenal lesions. Tumor size is a factor that might influence decision-making concerning the use of laparoscopic approach. The aim of this study was to analyze the results of adrenalectomy for tumors ≥6 cm in diameter. Methods: Two groups of patients were analyzed: first group comprised 441 patients with tumors <6 cm in diameter and second group consisted of 89 patients with tumors ≥6 cm. Both groups were compared with regard to the duration of surgery, intraoperative blood loss, conversion and complications rate. Results: Median duration of surgery in groups 1 and 2 amounted to 86.6 and 111.9 min (p < 0.0001), respectively. Median intraoperative blood loss in groups 1 and 2 was 56.5 and 172.8 ml (p < 0.0001), respectively. There was a linear relationship between tumor size and the duration of surgery, and between tumor size and intraoperative blood loss (p < 0.0001). There were 2 (0.5%) and 6 (6.7%) conversions in groups 1 and 2, respectively. There were 41 (9.3%) and 14 (15.7%) complications in groups 1 and 2 (p = 0.0692), respectively. Conclusions: Laparoscopic adrenalectomy of tumors ≥6 cm is more difficult, but it can be regarded safe and beneficial for patients.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Transperitoneal Lateral Adrenalectomy for Large Adrenal Tumors

Natkaniec¹,

Pędziwiatr²,

Wierdak³

et al. 2016

Urol Int

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“…Our own data from Germany support this view. (16,17,18,19,20,21,22,23,24), but there is no conclusive answer to date. As to the other two questions, the available literature is even scarcer (9,25,26,27).…”

Section: Surgerymentioning

confidence: 99%

EJE PRIZE 2014: Current and evolving treatment options in adrenocortical carcinoma: where do we stand and where do we want to go?

Ronchi

Kroiß

Sbiera

et al. 2014

European Journal of Endocrinology

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Adrenocortical carcinoma (ACC) is not only a rare and heterogeneous disease but also one of the most aggressive endocrine tumors. Despite significant advances in the last decade, its pathogenesis is still only incompletely understood and overall therapeutic means are unsatisfactory. Herein, we provide our personal view of the currently available treatment options and suggest the following research efforts that we consider timely and necessary to improve therapy: i) for better outcome in localized ACCs, surgery should be restricted to experienced centers, which should then collaborate closely to address the key surgical questions (e.g. best approach and extent of surgery) in a multicenter manner. ii) For the development of better systemic therapies, it is crucial to elucidate the exact molecular mechanisms of action of mitotane. iii) A prospective trial is needed to address the role of cytotoxic drugs in the adjuvant setting in aggressive ACCs (e.g. mitotane vs mitotaneC cisplatin). iv) For metastatic ACCs, new regimens should be investigated as first-line therapy. v) Several other issues (e.g. the role of radiotherapy and salvage therapies) might be answered -at least in a first step -by large retrospective multicenter studies. In conclusion, although it is unrealistic to expect that the majority of ACCs can be cured within the next decade, international collaborative efforts (including multiple translational and clinical studies) should allow significant improvement of clinical outcome of this disease. To this end, it might be reasonable to expand the European Network for the Study of Adrenal Tumors (ENSAT) to a truly worldwide international network -INSAT.

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“…Кроме того, в ряде исследований была доказана также возможность успешного применения эндоскопического доступа для выполнения операций по поводу неоплазий, в своем максимальном измерении значительно пре-вышающих вышеозначенное условное пороговое значение [5][6][7][8][9]. Некоторыми авторами получены обнадеживающие результаты у пациентов с малиг-низированными опухолями адреналовых желез при проведении лапароскопических адреналэктомий (ЛАЭ) на ранних стадиях злокачественного процес-са [10][11][12]. В целом проведенные исследования четко про-демонстрировали преимущества эндохирургическо-го доступа над традиционным открытым при вы-полнении АЭ.…”

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