Laparoscopic adrenalectomy for metastatic adrenal cancer with vena cava inferior resection

Abstract

The adrenal glands are a potential site of metastasis for various malignancies. Although laparoscopic adrenalectomy is the gold standard approach for adrenal gland diseases, it is controversial for primary or metastatic adrenal cancers because when adrenal metastases are symptomatic, the adrenal mass is usually adjacent to or has invaded the vena cava inferior (VCI), liver, or kidney. Laparoscopic adrenalectomy is difficult to perform in such cases. Described herein is laparoscopic adrenalectomy for metastatic right adrenal cancer adjacent to VCI. Abdominal magnetic resonance imaging and computed tomography of 66-year-old male patient treated for lung cancer demonstrated mass in right adrenal gland adjacent to IVC. Laparoscopic exploration revealed mass adjacent to VCI. For curative resection, lateral side of VCI was partially resected using endoscopic vascular staples and adrenalectomy was performed. The patient was discharged uneventfully at postoperative third day. Laparoscopic adrenalectomy can be performed safely with endoscopic vascular staples to remove adrenal tumor in patients with cancer, even with invasion of VCI.